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Old 10-09-2012
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Arrow Gyrus Daily Questions; Internal Medicine #48

A 50-year-old man complains of weakness. His symptoms began as difficulty with buttoning his shirt and using keys to open doors about 2 years ago. He was treated empirically with nonsteroidal anti-inflammatory medications for arthritis, but responded only minimally.
His symptoms have slowly progressed to the point where he has weakness in both hands and feet. He avoids going outside because of frequent falls. On examination, he has weakness and atrophy of the foot extensor and finger flex-ors. Proximal muscle strength is normal. Reflexes are nor-mal, and sensation is intact. He is able to rise out of a chair, but the Romberg test is not able to be performed due to weakness once standing. Cranial nerves are intact.
Serum creatine kinase is 600 U/L. Complete blood count, differential, electrolytes, and thyroid-stimulating hor-mone (TSH) are normal. Based on the clinical presenta-tion, what is the most likely diagnosis?

A. Dermatomyositis
B. Eosinophilic myofasciitis
C. Inclusion body myositis
D. Polymyositis
E. Hyperthyroidism
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Ans--C. Inclusion body myositis
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I would say C, the weakness is distal, others generally present as proximal weakness, I dont know anything about eosinophilic myofasciitis so i wont comment on that.
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(c) inclusion body myositis
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B or C.
I'd go with B (which I have no clue about) just because I am not sure bout C in a greater extent lol
-kinda makes me wanna think of herpes or something...
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Quote:
Originally Posted by cingulate.gyrus View Post
A 50-year-old man complains of weakness. His symptoms began as difficulty with buttoning his shirt and using keys to open doors about 2 years ago. He was treated empirically with nonsteroidal anti-inflammatory medications for arthritis, but responded only minimally.
His symptoms have slowly progressed to the point where he has weakness in both hands and feet. He avoids going outside because of frequent falls. On examination, he has weakness and atrophy of the foot extensor and finger flex-ors. Proximal muscle strength is normal. Reflexes are nor-mal, and sensation is intact. He is able to rise out of a chair, but the Romberg test is not able to be performed due to weakness once standing. Cranial nerves are intact.
Serum creatine kinase is 600 U/L. Complete blood count, differential, electrolytes, and thyroid-stimulating hor-mone (TSH) are normal. Based on the clinical presenta-tion, what is the most likely diagnosis?

A. Dermatomyositis
B. Eosinophilic myofasciitis
C. Inclusion body myositis
D. Polymyositis
E. Hyperthyroidism
By exclusion , C might be the answer.
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The answer is C. Inclusion body myositis

The inflammatory myopathies (polymyositis, dermatomyositis, and inclusion body myositis) are associated with unique clinical features. Inclusion body myositis is usually seen in patients ≥50 years and initially involves the distal muscles, especially the foot extensors and finger flexors.

Atrophy is seen along with weakness as this inflammatory myopathy runs a slowly progressive course, compared to polymyositis or dermatomyositis.

Polymyositis is a rare disorder that usually involves theproximal not distal muscles. It is a diagnosis of exclusion after a thorough medical examination
and muscle biopsy.

Dermatomyositis is distinguished by the classic heliotrope rash and associated skin findings, which may precede the development of clinical muscular
weakness.

Eosinophilic myofasciitis is associated with myalgias, skin induration, fatigue,
and eosinophilia in the peripheral blood as well as in endomysial tissue.

Hyperthyroidism would cause a reduced TSH. It may cause weakness, but is generally associated with other findings such as tremor, skin changes, and irritability.
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