Neuromyelitis optica preceded by hyperCKemia and a possible association with coxsackie virus group A10 infection

Abstract

We report the case of a 48-year-old woman presenting with an elevated serum creatine kinase level (hyper- CKemia) associated with an initial attack of neuromyelitis optica (NMO). The patient initially showed general fatigue with fever. Laboratory findings showed hyperCKemia and subsequently she developed a slight weakness of both lower limbs and reduced vision. Autoantibodies against aquaporin 4 were found in her serum, and a retrospective examination of viral titers indicated a possible coxsackie virus group A10 infection. The present case suggests that hyperCKemia-mediated disease onset is involved in some patients with NMO, and furthermore, it may be related to muscular destruction associated with viral infection. © 2013 The Japanese Society of Internal Medicine.