Clinical History:
Patient presented with progressive proximal weakness since August and severe x2 weeks.
Past medical history: hyperthyroidism, hyperlipidemia, herpes simplex, hypertension.
Medications: statin (discontinued 5 days before presentation), tirzepatide, bupropion, levothyroxine, and acyclovir.
Lab results: highest CK 15,991, elevated AST/ALT, WBC 14.7, CRP 0.5, ESR 14, general serologies negative (ANA negative, Jo 1 negative, SCL-70 negative, SM/RNP negative, RF negative). Clinical suspicion for myositis versus rhabdomyolysis.
What is in the yellow circle in Figure 1 below?
A. Necrotic fiber
B. Macrophages
C. Lymphocytes
D. Emperipolesis
Here is Figure 1 for reference:
Diagnosis:
Lymphocytes
Lymphocytes surrounding a small vessels as seen on toluidine blue stained 1μm-thick sections.
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