Differential Diagnosis for Elevated CK and Liver Enzymes

Single Most Likely Diagnosis

• Rhabdomyolysis: This condition, characterized by the breakdown of muscle tissue, is a common cause of elevated creatine kinase (CK) levels. The liver enzyme elevation could be secondary to the muscle breakdown or due to the underlying cause of rhabdomyolysis, such as severe physical exertion, drug abuse, or certain medications.

Other Likely Diagnoses

• Viral Hepatitis: Certain viral hepatitis infections, such as hepatitis B or C, can cause significant elevations in liver enzymes. While CK elevation is not a primary feature, muscle involvement or concomitant conditions could lead to elevated CK levels.
• Alcoholic Hepatitis: Alcohol abuse can lead to liver damage and elevated liver enzymes. CK levels might be elevated due to alcohol-related muscle damage or other associated conditions.
• Drug-Induced Liver Injury (DILI): Various medications and drugs can cause liver enzyme elevations. Some drugs might also lead to muscle damage, resulting in elevated CK levels.

Do Not Miss Diagnoses

• Wilson's Disease: A genetic disorder leading to copper accumulation in the liver and other tissues. It can cause severe liver damage and elevated liver enzymes. Muscle symptoms are less common but can occur, making it a critical diagnosis not to miss due to its potential for severe outcomes if untreated.
• Autoimmune Hepatitis: An autoimmune condition causing liver inflammation and elevated liver enzymes. While less common, it can have significant consequences if not diagnosed and treated promptly.
• Alpha-1 Antitrypsin Deficiency: A genetic disorder that can lead to liver disease and, in some cases, muscle symptoms. It's crucial to diagnose this condition to provide appropriate management and genetic counseling.

Rare Diagnoses

• McArdle Disease (Glycogen Storage Disease Type V): A rare genetic disorder affecting muscle glycogen metabolism, leading to elevated CK levels after exercise. Liver enzyme elevations might be seen due to secondary effects or associated conditions.
• Debranching Enzyme Deficiency (Glycogen Storage Disease Type III): Another rare genetic disorder affecting glycogen metabolism, which can lead to both liver and muscle involvement, resulting in elevated liver enzymes and CK levels.
• Mitochondrial Myopathies: A group of rare disorders affecting the mitochondria, which can lead to muscle weakness and elevated CK levels. Some forms may also involve the liver, causing elevated liver enzymes.