Table of Contents
Washington University Experience | MUSCLE | Autophagic myopathy | 11A0 Case 11 History
Case 11 History ---- The patient is a 78 year old man with a history of diabetes, chronic renal failure, syncopal episodes with orthostasis, previous (16 years) lumbar spinal surgery with residua (foot drop) and hypercalcemia provoking concern for possible sarcoidosis. The patient has experienced a few years of severe bilateral lower extremity weakness and sensory loss. EMG/NCS shows diffuse severe axonal sensorimotor peripheral neuropathy of unclear etiology and myopathy. He was hospitalized for a continuing increase in serum calcium and creatinine. Calcitriol levels were also increased, providing additional concern for sarcoidosis, although there was no biopsy proof. As a result the patient was treated with IV bisphosphonate and oral prednisone. Renal failure increased requiring dialysis. He was started on Plaquenil 200mg BID, which is a standard dose of hydroxychloroquine for adults with autoimmune conditions such as systemic lupus erythematosus, sarcoidosis or rheumatoid arthritis. Thanks to Drs. R Bucelli and A Pestronk for the use of their histochemical and immunohistochemical material from this case.
