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To the Editor: Suzuki et al.1 described 3 patients with neuromyelitis optica (NMO) preceded by hyperCKemia episode. I have cared for 2 patients with relapsing-remitting multiple sclerosis (MS) who presented with hyperCKemia.
In August 1997, a 35-year-old man had transverse myelitis. He subsequently had a month of diplopia in April 2000. He presented to me in August 2000 with a 3- to 4-week history of tingling in both hands. His examination had normal results except for impaired tandem gait. Laboratory tests were significant for CK of 3,000 IU/L (normal range 26–170). Repeat CK 3 days later was 1,250 IU/L. Brain MRI showed moderate plaque load. Spine MRI showed plaques at C2 and T11. Lumbar puncture revealed elevated immunoglobulin G of 9.5 mg/dL (normal 0.5–6.1) and no oligoclonal bands. EMG/NCV was performed twice and did not demonstrate myopathy. He was started on glatiramer acetate and since CK normalized by October 2000, muscle biopsy was …
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