title: 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 (hyperCKemia) 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.
authors.affiliation: Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology, Yamagata University Faculty of Medicine, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Okada
authors.forename: Manabu
authors.initials: M
authors.lastname: Wada
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Sato
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Yamaguchi
authors.forename: Haruko
authors.initials: H
authors.lastname: Tanji
authors.forename: Katsuro
authors.initials: K
authors.lastname: Kurokawa
authors.forename: Toru
authors.initials: T
authors.lastname: Kawanami
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Takahashi
authors.forename: Takeo
authors.initials: T
authors.lastname: Kato
mesh_terms: D051401:Aquaporin 4 / Q000276:immunology; D001323:Autoantibodies / Q000097:blood; D003384:Coxsackievirus Infections / Q000150:complications* / Q000201:enzymology / Q000821:virology; D003402:Creatine Kinase / Q000097:blood*; D004770:Enterovirus / Q000145:classification; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009471:Neuromyelitis Optica / Q000201:enzymology* / Q000209:etiology* / Q000473:pathology; D009900:Optic Nerve / Q000276:immunology / Q000473:pathology; D013116:Spinal Cord / Q000276:immunology / Q000473:pathology
chemical_list: C496030:AQP4 protein, human; D051401:Aquaporin 4; D001323:Autoantibodies; D003402:Creatine Kinase