Postgraduate Medical Journal 2003;
79:421-423; doi:10.1136/pmj.79.933.421-a
Copyright © 2003 The Fellowship of Postgraduate Medicine.
Postgraduate Medical Journal 2003;79:421-423
© 2003 Fellowship of Postgraduate Medicine
SELF ASSESSMENT ANSWER
A bed bound patient
| The first 150 words of the full text of this article appear below. |
Q1: What is the differential diagnosis and the most likely diagnosis?
The differential diagnosis is wide (box 1
, which is not exhaustive) and influenced somewhat by the past medical history. However, the most likely diagnosis is polymyositis. The presentation with proximal muscle tenderness, and importantly weakness, together with a raised ESR and raised creatine kinase is typical. The clinical picture may evolve over several weeks or months, as in this case.
Box 1: Differential of chronic proximal muscle weakness in adults- Polymyositis.
- Dermatomyositis.
- Inclusion body myositis.
- Virally mediated myositis: HIV, HTLV-1, influenza, coxsackie, adenovirus, herpes simplex virus, Epstein-Barr virus.
- Chronic inflammatory demyelinating polyradiculoneuropathy.
- Endocrine myopathy: hyperthyroidism, hypothyroidism, acromegaly, Cushing’s syndrome, Addison’s disease, Conn’s syndrome, hypoparathyroidism.
- Myasthenia gravis.
- Sarcoid myopathy.
- Diabetic amyotrophy.
- Drug induced: alcohol, ß-blockers, fibrates, diuretics, phenytoin, vincristine, zidovudine.
- Muscular dystrophies: limb girdle dystrophy, facioscapulohumeral dystrophy.
- Disorders of glycogen metabolism: acid maltase deficiency, myophosphorylase deficiency.
- Mitochondrial cytopathy.
Had the appropriate skin manifestations been present, dermatomyositis would have been an important consideration. . . . [Full text of this article]
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