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In the published literature on Eastern equine encephalitis, a description of serum creatine kinase changes has not been found. Here, in three cases of Eastern equine encephalitis, there was a consistent pattern of levels of serum creatine kinase consisting of an increase to a maximum and then a decline.
Case 1: A man in his 70s was admitted to hospital 4 days after onset of headache and speaking difficulty. Medications included furosemide 10 mg, spironolactone 12 mg, hydrochlorothiazide 12 mg and simvastatin 10 mg/day. Physical examination demonstrated lethargy, meningeal signs and left upper extremity paresis and lower extremity paresis. Laboratory reported cerebrospinal fluid containing Eastern equine encephalitis virus nucleic acid meeting the criteria for a confirmed case.1 Elevation of serum total creatine kinase (CK) (normal 20–200 units/L) was noted 4 days after, and peaked 7 days after, onset of symptoms (figure 1). Creatinine kinase – myocardial isoenzyme (CK-MB) levels were 3.1, 2.7, 1.9, 3.1, 13.9, 4.9, 2.6 and 2.9 ng/mL (normal 0.0–5.0) (figure 1). Serum troponin T levels were 0.1 and 0.1 ng/mL (normal 0.0–0.1). MRI of the brain shows abnormal left basal ganglia and bilateral caudate, thalamus, putamen and temporal lobes. At 5 days, parkinsonian rigidity developed. At 11 days, coma and apneic episodes developed. At 16 days after onset of symptoms, the patient was pronounced dead. Autopsy was not performed.2
Contributors All persons designated as authors qualify for authorship and participated sufficiently in the work to take public responsibility for appropriate portions of the content. JAS designed the study, analysed data, drafted the initial manuscript and approved the final manuscript as submitted. DCB contributed to the discussion, revised the manuscript and approved the final manuscript as submitted. JO conceived of the study, synthesised data, revised the manuscript and approved the final manuscript as submitted.
Funding This work was supported by full-time salaries at the Department of Health of the State of New York.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.