P1252 - Persistent Asymptomatic Elevation of Creatine Phosphokinase in a Patient With Crohn’s Ileitis on Vedolizumab Therapy

Natasha Nazir, DO, MS, Tyler Santos, MD, MS, Lindsey Donnelly, MD, Ramona Rajapakse, MD, FACG
Mather Hospital, Northwell Health, Port Jefferson, NY

Introduction: Gut-selective anti-integrin monoclonal antibodies, including Vedolizumab, are effective therapies for managing severe cases of inflammatory bowel disease. Unlike tumor necrosis factor inhibitors, which have been associated with myopathic side effects, Vedolizumab targets the α4β7 integrin, inhibiting leukocyte migration into the gastrointestinal mucosa. One study has shown that over 30% of IBD patients receiving infliximab therapy may develop asymptomatic elevations in serum creatine kinase as an adverse effect. However, data on Vedolizumab-induced CK abnormalities remain limited.

Case Description/

Methods: A 36-year-old non-smoking male with a history of Crohn’s ileitis diagnosed at age 24 well-controlled on Vedolizumab, was found to have persistently elevated creatine kinase (CK) levels, peaking at 3000 U/L, with subsequent values ranging from 1000 to 2437 U/L for one year. CK Isoenzymes revealed benign skeletal muscle source rather than inflammatory myopathy. He remained asymptomatic, denying myalgias, weakness, dark urine, or exercise intolerance. Neurological examination and EMG were unremarkable. A muscle biopsy was offered but declined. Cardiac evaluation, including stress testing and echocardiography, was unrevealing. Autoimmune panel ANA, dsDNA, SSA/SSB, Smith, RNP, RF, and CCP all negative. ESR and CRP were within normal limits. Normal thyroid function tests. He denied use of steroids, statins, creatine, supplements, or alcohol. Family history was negative for neuromuscular disease. CMP notable only for mild transaminitis (AST 74, ALT 69), with normal GGT, Uric acid and G6PD levels. Infectious workup including hepatitis B/C panel and QuantiFERON testing was negative. CBC was unremarkable and hepatic steatosis noted on imaging with normal renal function.

Discussion: This case highlights that asymptomatic CK elevations, though not widely reported, may occur in some patients on biologic therapy. Studies have noted such elevations with TNF inhibitors like infliximab and, less frequently, with vedolizumab, though the mechanism is unclear. Clinicians should keep a broad differential and rule out other causes—such as statin use, thyroid dysfunction, or myopathies—before attributing elevated CK to biologic therapy. Sutter M, Hruz P, Niess JH. High serum creatine kinase levels in infliximab- and vedolizumab-treated inflammatory bowel disease patients. Inflamm Intest Dis, 2021; 6: 165–174.

Disclosures:
Natasha Nazir indicated no relevant financial relationships.
Tyler Santos indicated no relevant financial relationships.
Lindsey Donnelly indicated no relevant financial relationships.
Ramona Rajapakse indicated no relevant financial relationships.

Natasha Nazir, DO, MS, Tyler Santos, MD, MS, Lindsey Donnelly, MD, Ramona Rajapakse, MD, FACG. P1252 - Persistent Asymptomatic Elevation of Creatine Phosphokinase in a Patient With Crohn’s Ileitis on Vedolizumab Therapy, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.