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Washington University Experience | MUSCLE | Autophagic myopathy | 10A1 (Case 10) H&E 20X 1
Case 10 History ---- A 79-year-old man with seronegative rheumatoid arthritis on methotrexate and adulimumab-ryvk experienced a few years of bilateral lower extremity sensory symptoms and asymmetric leg weakness on exam. Electrodiagnostic testing showed a sensorimotor axonal polyneuropathy. Neuromuscular ultrasound showed no abnormalities in nerves of the left leg. Neuropathy autoantibodies were negative. ANA was positive at 1:1280 in a speckled pattern. Biopsies of quadriceps and sural nerve were performed. ---- 10A1 The H&E stained muscle viewed at lower magnification is deceptively bland. However, even then there are numerous atrophic muscle cells with multiple nuclei tucked in adjacent to normal muscle fibers. (H&E)
