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May 31, 1976

Ischemic Rhabdomyolysis

JAMA. 1976;235(22):2388. doi:10.1001/jama.1976.03260480010003

To the Editor.—  In their article (235: 632, 1976), Russell et al have reported on a case of ischemic rhabdomyolysis of the lower extremity in which they found high levels of creatine phosphokinase isoenzyme 2. Absence of electrocardiographic changes suggestive of myocardial infarction and nonreversed lactic dehydrogenase1lactic dehydrogenase2 ratio ruled out this finding of serum CPK2 isoenzyme as the marker of myocardial necrosis.Their statement of the nonspecificity of this enzyme in the latter condition seems to be corroborated by its presence in other myopathies.Although the authors appear to have limited their comments to this enzyme, I believe their report could have gained additional significance had they stressed the central role played by the sudden iliac-artery thrombosis as the initiating cause of the clinical and biochemical manifestations. While infrequently reported, severe metabolic complications associated with acute arterial occlusions are not uncommon. Unfortunately, they are rarely recognized