{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T17:08:15Z","timestamp":1793984895750,"version":"4.8.0"},"reference-count":6,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2024,11,2]],"date-time":"2024-11-02T00:00:00Z","timestamp":1730505600000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Macro-creatine kinase (macro-CK) type 1, a macroenzyme composed of creatine kinase (CK) and immunoglobulin, is associated with hypothyroidism, tumour, autoimmune diseases, myositis, and cardiovascular diseases, and may even be found in the absence of associated pathology. However, its relationship with coronavirus disease (COVID-19) infection remains unreported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>An 11-year-old male patient presented with recurrent myocardial enzyme abnormalities, mainly manifested as elevated activities of CK and CK isoenzyme [particularly CK-myocardial band (MB)] with activity inverse (CK-MB higher than CK). Dynamic examinations revealed a continuous increase in CK-MB activity closely related to infection, peaking immediately after COVID-19 infection (CK 1838\u2005U\/L and CK-MB 1644\u2005U\/L). Nonetheless, the patient remained asymptomatic, with the normal results of cardiac magnetic resonance imaging and muscle biopsy and persistently normal results of echocardiogram and electrocardiogram. He had normal values of CK-MB mass and high-sensitivity troponin T (hs-cTnT) suggesting possible false elevation of CK-MB activity assayed via immunoinhibition-based CK-MB measurement. Macro-CK type 1 was confirmed by CK isoenzyme electrophoresis with a macro-CK type 1 band detected in the patient\u2019s serum. The patient remained asymptomatic over a year\u2019s follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The sustained pseudoelevation of CK-MB activity caused by macro-CK type 1 is often misdiagnosed as myocardial damage. This diagnosis can be established via agarose gel electrophoresis of CK and CK mass assay. This case illustrates that COVID-19 infection closely correlates with macro-CK type 1 occurrence. It highlights the clinical value of understanding the relationship and emphasizes the importance of education for differential diagnosis to avoid misdiagnosing myocardial damage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytae594","type":"journal-article","created":{"date-parts":[[2024,10,31]],"date-time":"2024-10-31T08:17:07Z","timestamp":1730362627000},"source":"Crossref","is-referenced-by-count":3,"title":["COVID-19 infection-induced worsening of recurrent CK-MB isozyme elevation due to macro-CK type 1 in a child: case report"],"prefix":"10.1093","volume":"8","author":[{"given":"Chenxi","family":"Zhang","sequence":"first","affiliation":[{"name":"Graduate Affairs Office, Xi\u2019an Medical College , No 1 Xinwang Road, Xi\u2019an 710000 ,","place":["China"]},{"name":"Department of Cardiology, Affiliated Children\u2019s Hospital of Xi\u2019an Jiaotong University (Xi\u2019an Children\u2019s Hospital) , No 69, Xijuyuan Lane, Xi\u2019an 710003 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Zhou","sequence":"additional","affiliation":[{"name":"Key Laboratory of Precision Medicine to Pediatric Diseases of Shaanxi Province, Affiliated Children\u2019s Hospital of Xi\u2019an Jiaotong University (Xi\u2019an Children\u2019s Hospital), Xi\u2019an Key Laboratory of Children\u2019s Health and Diseases, Shaanxi Institute for Pediatric Diseases , No 69, Xijuyuan Lane, Xi\u2019an 710003 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Zhang","sequence":"additional","affiliation":[{"name":"Clinical Laboratory, Affiliated Children\u2019s Hospital of Xi\u2019an Jiaotong University (Xi\u2019an Children\u2019s Hospital ), No 69, Xijuyuan Lane, Xi\u2019an 710003 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Lei","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Affiliated Children\u2019s Hospital of Xi\u2019an Jiaotong University (Xi\u2019an Children\u2019s Hospital) , No 69, Xijuyuan Lane, Xi\u2019an 710003 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7580-4693","authenticated-orcid":false,"given":"Yanmin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Affiliated Children\u2019s Hospital of Xi\u2019an Jiaotong University (Xi\u2019an Children\u2019s Hospital) , No 69, Xijuyuan Lane, Xi\u2019an 710003 ,","place":["China"]},{"name":"Key Laboratory of Precision Medicine to Pediatric Diseases of Shaanxi Province, Affiliated Children\u2019s Hospital of Xi\u2019an Jiaotong University (Xi\u2019an Children\u2019s Hospital), Xi\u2019an Key Laboratory of Children\u2019s Health and Diseases , Shaanxi Institute for Pediatric Diseases, No 69, Xijuyuan Lane, Xi\u2019an 710003 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,11,2]]},"reference":[{"key":"2024111513273066600_ytae594-B1","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1161\/01.CIR.84.1.333","article-title":"Canine myocardial creatine kinase isoenzymes after chronic coronary artery occlusion","volume":"84","author":"Sharkey","year":"1991","journal-title":"Circulation"},{"key":"2024111513273066600_ytae594-B2","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.1515\/cclm-2020-0811","article-title":"Macro creatine kinase in an asymptomatic patient: a case report","volume":"59","author":"Zhang","year":"2020","journal-title":"Clin Chem Lab Med"},{"key":"2024111513273066600_ytae594-B3","doi-asserted-by":"crossref","first-page":"187","DOI":"10.3109\/10408368109105871","article-title":"Creatine kinase isoenzymes: electrophoretic and quantitative measurements","volume":"15","author":"Foreback","year":"1981","journal-title":"Crit Rev Clin Lab Sci"},{"key":"2024111513273066600_ytae594-B4","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1038\/s41574-020-0365-5","article-title":"Creatine metabolism: energy homeostasis, immunity and cancer biology","volume":"16","author":"Kazak","year":"2020","journal-title":"Nat Rev Endocrinol"},{"key":"2024111513273066600_ytae594-B5","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/S0140-6736(12)61266-5","article-title":"Acute pneumonia and the cardiovascular system","volume":"381","author":"Corrales-Medina","year":"2013","journal-title":"Lancet"},{"key":"2024111513273066600_ytae594-B6","doi-asserted-by":"crossref","first-page":"37","DOI":"10.3949\/ccjm.83a.14120","article-title":"Approach to asymptomatic creatine kinase elevation","volume":"83","author":"Moghadam-Kia","year":"2016","journal-title":"Cleve Clin J Med"}],"container-title":["European Heart Journal - 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