Differential Diagnosis for 14 yo Male with Muscle Pain and CK of 589
Single Most Likely Diagnosis
- Duchenne Muscular Dystrophy (DMD): Although the patient's age is on the higher end for a diagnosis of DMD, the significantly elevated CK level and muscle pain are consistent with this condition. DMD is a genetic disorder characterized by progressive muscle degeneration and weakness, and it often presents in childhood.
Other Likely Diagnoses
- Viral Myositis: This condition, often caused by influenza or coxsackievirus, can lead to muscle pain and elevated CK levels. The diagnosis is plausible given the acute presentation and the potential for viral infections in adolescents.
- Exertional Rhabdomyolysis: This condition occurs due to intense physical activity leading to muscle breakdown. It's a possible diagnosis given the patient's age and potential for engaging in strenuous exercise, which could result in muscle pain and elevated CK.
- Lyme Disease: In areas where Lyme disease is prevalent, it could be a consideration, especially if the patient has been exposed to ticks. Lyme disease can cause muscle pain and slightly elevated CK levels, although levels as high as 589 would be unusual.
Do Not Miss Diagnoses
- Rhabdomyolysis due to Other Causes (e.g., drug-induced, heat stroke): While less common, these conditions can lead to very high CK levels and are medical emergencies due to the risk of acute kidney injury. Missing these diagnoses could be catastrophic.
- McArdle Disease (Glycogen Storage Disease Type V): This rare genetic disorder affects the muscle's ability to break down glycogen for energy. It can cause muscle pain and elevated CK levels after exercise. Although rare, it's a condition that significantly impacts quality of life and should not be missed.
- Toxic Myopathies (e.g., statin-induced): Certain medications and toxins can cause muscle damage. Identifying and removing the offending agent is crucial for treatment and prevention of further muscle damage.
Rare Diagnoses
- Polymyositis: An inflammatory muscle disease that can cause muscle weakness and pain, and elevated CK levels. It's rare in adolescents and more commonly seen in adults.
- Dermatomyositis: Similar to polymyositis but also includes skin manifestations. It's rare and would be distinguished by specific dermatological findings.
- Mitochondrial Myopathies: A group of disorders affecting the mitochondria, leading to muscle weakness and other systemic symptoms. These are rare genetic conditions that might present with elevated CK levels and muscle pain among other symptoms.