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Neuromyelitis optica (NMO) is an inflammatory central nervous system (CNS) disease associated with autoantibodies that target aquaporin-4, an astrocyte water channel. These researchers report on three patients who developed initial NMO symptoms following transient, self-limited episodes of fatigue and creatine kinase (CK) elevation (range, 12,520–59,660 IU/L) of unknown cause. The cases were identified through retrospective review of 733 serum samples from a diagnostic laboratory that provides testing for aquaporin-4 antibodies. In one pediatric case, CK elevation recurred without an associated NMO relapse (NMO relapses occurred independently). The authors could find no cause for the CK elevations; muscle biopsies were not performed.
Because…