Can a cold cause elevated Creatine Kinase (CK) levels?

Can a Cold Cause High CK?

Yes, viral infections including the common cold can cause elevated creatine kinase (CK) levels due to inflammatory processes affecting muscle tissue. This has been documented in influenza and other viral infections 1.

Mechanisms of CK Elevation in Viral Infections

• Direct viral invasion: Viruses can directly invade skeletal muscle, causing focal necrosis and myopathic changes 1
• Inflammatory response: Systemic inflammation from infections can affect muscle tissue
• Fever-associated elevation: Studies show that 28% of patients with febrile illnesses have elevated CK levels, compared to only 6% of afebrile controls 2

Other Common Causes of CK Elevation

CK elevation is more commonly associated with:

1. Exercise-induced muscle damage: Particularly unaccustomed or eccentric exercises 3
2. Medications: Especially antipsychotics and statins 4
3. Muscle disorders: Including muscular dystrophies and inflammatory myopathies 5
4. Trauma or injury: Direct muscle damage from trauma
5. Alcohol abuse: Can cause direct muscle toxicity 6

Clinical Significance and Evaluation

When evaluating elevated CK in the context of a cold:

• Mild elevations (1-3× normal) are often benign and temporary during viral illnesses
• Moderate elevations (3-10× normal) warrant closer monitoring
• Severe elevations (>10× normal) require investigation for other causes or complications

Key factors to assess:

• Associated symptoms: Muscle pain, weakness, or tenderness suggest more significant muscle involvement 3
• Hydration status: Dehydration can worsen CK elevation and increase risk of renal complications
• Medication review: Check for medications that may contribute to CK elevation
• Severity of elevation: Higher levels correlate with greater risk of complications 6

Management Approach

1. For mild-moderate CK elevation with cold symptoms:

   • Ensure adequate hydration
   • Monitor CK levels if symptoms persist
   • Treat underlying viral infection symptomatically

2. For significant CK elevation (>5× normal):

   • Assess renal function (BUN, creatinine)
   • Consider checking urine myoglobin if very high CK
   • Evaluate for other contributing factors

3. For severe elevation or persistent elevation:

   • Consider referral to specialist (rheumatologist or neurologist)
   • More extensive workup may be needed to rule out other causes 3

Monitoring and Follow-up

• Repeat CK measurement after resolution of cold symptoms if levels were significantly elevated
• If CK remains elevated after recovery, further investigation is warranted

Clinical Pearls

• CK elevation is not specific to any particular diagnosis but can occur in many febrile illnesses 2
• The combination of fever and elevated CK should prompt consideration of viral myositis
• Influenza viruses have been isolated from muscle biopsy specimens in patients with elevated CK 1
• Patients with fever and elevated CK may have longer hospital stays and more complications 1