Case History:
A 72 year-old man presented to the Emergency Department with a 6-week
history of progressive proximal symmetric muscle weakness. He noted some
difficulty rising from a seated position, climbing stairs, and lifting
up his arms to ninety degrees independently. He had no difficulty
chewing, talking, swallowing, or opening and closing his eyes. He had
diffused joint pain including in his proximal muscle groups in both limb
girdles. He had no rash on his face, chest, back, hands, or on his
eyelids. One week prior to this presentation, he was diagnosed with left
lung basal pneumonia and treated with oral antibiotics. He had fatigue,
malaise, night sweats, and dyspnea on exertion. He did not have
abdominal pain, change in bowel habits, or black or bloody stools. He
did not have dysuria, difficulty voiding, or hematuria. At the time of
admission, he was on metoprolol succinate 50 mg daily, furosemide 20 mg
daily, and aspirin 81 mg daily. He had been on atorvastatin and
sacubitril-valsartan for a number of years, but these medications had
been discontinued at the onset of his muscle weakness.
He has paraoesophageal hiatal hernia, Grover’s disease, dyslipidemia,
hypertension, coronary artery disease, heart failure, and atrial
fibrillation. His mother had been diagnosed with dermatomyositis at the
age of 72.
His initial vital signs were normal. He had muscle atrophy in shoulder
and hip muscles, but no atrophy was noted in finger flexors. No muscle
tremors or fasciculations were observed. His right upper extremity
muscle power was 3/5, and 2/5 strength in the left upper extremity. The
power in his left and right hip flexors was 2/5. He had 5/5 power in his
hands and fingers. His deep tendon reflexes were normal. The nail and
nailfold capillaroscopy examination was normal. His joint, pulmonary,
and abdominal examinations were normal.