# Paliperidone-Induced Massive Asymptomatic Creatine Kinase Elevation in Youth: From a Case Report to Literature Review

## TL;DR

This paper reports a case of a youth with elevated creatine kinase levels due to paliperidone and reviews the condition's implications for diagnosis and treatment.

## Contribution

The paper presents the first reported case of MACKE in an adolescent treated with paliperidone and reviews the clinical implications.

## Key findings

- MACKE is more commonly associated with second-generation antipsychotics than first-generation ones.
- MACKE is often asymptomatic and self-limiting but may require drug discontinuation.
- Diagnosing MACKE is crucial to avoid unnecessary monitoring and treatment changes.

## Abstract

Background/Objectives: Unlike rhabdomyolysis and neuroleptic malignant syndrome (NMS), massive asymptomatic creatine kinase elevation (MACKE) represents a condition commonly detected during routine screening in patients receiving antipsychotic drugs. In particular, current evidence indicates a greater incidence of this condition in patients without signs of NMS, rhabdomyolysis, or other causes of CK increase during exposure to second-generation antipsychotics (SGAs) than first-generation antipsychotics (FGAs) with a variable onset and duration. Although its pathophysiology is still not fully elucidated, MACKE has usually been recognized as a self-limiting condition, but drug discontinuation might also be required to successfully revert it. Overall, knowledge in this field is mainly extrapolated from adult data, while similar evidence in youths is still limited. As clinicians might often deal with MACKE, its understanding needs to be expanded to avoid misdiagnosis, potentially leading to wasteful healthcare spending and unfavorable patient outcomes. Methods: By reporting the first case of MACKE in an adolescent receiving an SGA, namely paliperidone, we also aimed to provide a comprehensive overview of this medical condition. Conclusions: Making a MACKE diagnosis is essential since its relevant clinical and economic implications are mainly related to unnecessary closer laboratory monitoring or therapeutic changes (e.g., drug discontinuation or switch to another medication).