Several possibilities may explain the low myoglobin/CK ratio of 0.11 in our case: 1) accumulation of CK due to its long half-life may have caused an overestimation of ongoing muscle damage; 2) activation of extrarenal myoglobin metabolism, possibly in the liver and spleen, may have led to only a mild increase in serum myoglobin concentrations [4,19]; and 3) CK, which has higher permeability of the myocyte membrane than myoglobin, may have leaked more predominantly, as suggested in acute psychotic patients with rhabdomyolysis [20]. Here, MB is linked to rhabdomyolysis.