A Woman With Weakness, Elevated Cholesterol, and Serum Creatine Kinase Levels

A 64-year-old woman was referred because of a 5-year history of difficulty getting up from a chair, going up and down stairs, and muscle tightness with pain particularly in the thighs after exercising. Workup revealed an elevated serum creatine kinase (CK).

She had been on atorvastatin calcium for hyperlipidemia, and her problems were thought to be related to the drug. The drug was discontinued, but she remained symptomatic.

Previous workup revealed a normal EMG, and a myelogram that showed a mild lumbar stenosis.

The patient was hypertensive on diltiazem and on clopidogrel. She had no difficulty swallowing or breathing, and her review of systems was negative. She did not smoke or drink alcohol. Family history was negative.

Examination showed normal mentation and cranial nerves without facial, tongue, or palatal weakness. She had difficulty rising from a chair and sitting from a supine position, but gait was normal; there was iliopsoas and glutei weakness of 4−/5. Other muscle groups were normal. There was no atrophy or fasciculations. Reflexes were normal without slow relaxation. There was no myoedema during muscle percussion. There were no Babinski signs. Sensory examination to position, vibration, pain, and temperature was normal. Coordination was also normal. No myotonia was detected.

Blood work, including erythrocyte sedimentation rate, was normal except for serum CK of 1484 IU/L (normal, <200 IU/L); aspartate transaminase was 95 IU/L (normal, 0–40 IU/L), and alanine transaminase was 88 IU/L (normal, 30–65 IU/L).