HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this link to a friend Similar articles in this journal Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content Topic Collections Relevant Article

A bed bound patient

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]

Relevant Article

A bed bound patient

G G Hanna and G V McDonnell
Postgrad. Med. J. 2003 79: 418. [Extract] [Full Text] [PDF]