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We have seen a patient with very high total CK activity (20,380 U) who had a colon colon carcinoma that perforated. The total CK activity was 514 U a day before perforation. 99% of the CK was CK-BB (Arch Pathol Lab Med 123:461-462, 1999). To our knowledge such high total CK values due to CK-BB were not reported before. Adrian Vladutiu %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%