Case 1 History ---- The patient is a 57-year-old man with joint pain, a 40-pound weight loss, bilateral leg muscle weakness and skin rash, concerning for dermatomyositis. Examination shows diffuse joint pain, bilateral leg weakness, possibly symmetric, decreased pin sensation in the legs, and possible Gottron's papules. CK is elevated at 241. EMG/NCS is consistent with irritable myopathy based on the presence of fibrillations and positive sharp waves in many of the muscles examined with complex repetitive discharges, indicating chronicity. There was early recruitment of brief, small motor unit potentials in many of the muscles tested. A myopathy panel shows NT5C1A and borderline Mi-2a antibodies. Diagnostic question: Rule out inflammatory myopathy versus inclusion body myositis. Operative Procedure: Muscle biopsy.
