A Strong Diagnosis of Weakness
Journal of Hospital Medicine 12(12). 2017 December;:989-993. Published online first October 4, 2017 | 10.12788/jhm.2858
December 1, 2017|Journal of Hospital Medicine
The approach to clinical conundrums by an expert clinician is revealed through the presentation of an actual patient’s case in an approach typical of a morning report. Similar to patient care, sequential pieces of information are provided to the clinician, who is unfamiliar with the case. The focus is on the thought processes of both the clinical team caring for the patient and the discussant.
© 2017 Society of Hospital Medicine
KEY TEACHING POINTS
- Proximal muscle–dominant weakness is the characteristic feature in inflammatory myopathies like PM and DM. Myopathy causing proximal and distal weakness is more characteristic of sarcoidosis, IBM, alcohol, and statins.
- Elevations of urinary Times New Romanβ2-microglobulin and N-acetyl-D-glucosamine are often observed in inflammatory muscle diseases because of myoglobin-induced tubulointerstitial damage. These findings may also be caused by other conditions that affect the tubules, such as lupus nephritis, Sjogren’s syndrome, or renal sarcoidosis.
- Hypercalciuria in a patient with myopathy could suggest an underlying granulomatous disorder, such as mycobacterial infection, granulomatosis with polyangiitis, or sarcoidosis.
- The striking uptake within systemic skeletal striated muscles on gallium scintigraphy and “tiger man” appearance on FDG PET/CT are characteristic features of acute sarcoid myopathy; these are not common in other inflammatory myopathies.
Disclosure
Drs. Sudo, Wada, Narita, Mba, and Houchens have no conflicts of interest to disclose.
