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Washington University Experience | MUSCLE | Inclusions - Membranous, multilamellar | 1A1A-Case-1-EM006-Copy.jpg

Case 1 History ---- The patient is a 41 year old man with a history of possible acute disseminated encephalomyelitis in 2001, who presents in 2014 with encephalopathy and diffuse cerebral edema on head CT scan. The differential diagnosis includes a demyelinative or metabolic process, particularly a mitochondrial disease. Operative procedure: Muscle biopsy. ---- Light microscopy showed mild generalized atrophy and marginally increased lipid droplets in muscle fibers suggesting disuse. Ultrastructure was used to further examine mitochondrial number and appearance. ---- 1A1A,B Ultrastructural examination demonstrated subsarcolemmal collections of mitochondria forming large aggregates, of unusual sizes and shapes often accompanied by lipid droplets but did not show parking lot inclusions. There are significant amounts of infiltrating glycogen. The diagnosis of mitochondrial myopathy usually involves more substantial alterations than these. (electron micrographs)

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