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Currently filtering by tag: Rhabdomyolysis

Lipid Storage Myopathy

Lipid Storage Myopathy, Arkana Laboratories, neuro notes, neuropathology, molecular pathology
This adult patient presented with progressive muscle weakness, elevated CK, and was admitted for rhabdomyolysis. Skeletal muscle biopsy was performed of the quadriceps (Image 1, Hematoxylin and eosin-stained frozen section, original magnification x200). What is your diagnosis?       ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​...

Diagnose This (November 19, 2018)

Rhabdomyolysis in kidney biopsy at Arkana Laboratories
What is your diagnosis? What additional stains would you like to confirm your diagnosis?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​...

A source of myoglobinuria…

The image shows a frozen cross section of skeletal muscle from a patient with rhabdomyolysis, which included the full clinical syndrome of muscle pain, weakness, dark urine, and markedly elevated serum creatine kinase.  The image shows three necrotic fibers engulfed by macrophages (arrow).  So what causes such muscle injury?  The broad differential diagnosis includes trauma, drugs (e.g. statins, alcohol, heroin, cocaine), toxins (e.g. metabolic poisons, animal venom), inflammatory myopathy, immune-mediated necrotizing myopathy (e.g. anti-HMG CoA reductase associated myopathy), infection (e.g. EBV, influenza), paraneoplastic myopathy, and metabolic myopathy (e.g. disorders of glycolysis, lipid metabolism, mitochondria).

Diagnose This! (July 24, 2017)

What is your diagnosis?       ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​   ​  ...

Myoglobin Casts

A 54-year-old man with a history of hypertension and hypercholesterolemia presented with complaints of generalized “muscle stiffness” and cola-colored urine. He was found to have markedly elevated serum creatinine and creatine kinase levels. A renal biopsy showed acute tubular injury with numerous pigmented casts (Fig 1), which were proven to be myoglobin casts by immunohistochemistry (Fig 2). The etiology of the patient’s myoglobinuria was thought to be statin medication, the dose of which had recently been increased. Here is a link to a recent article describing the morphologic spectrum of myoglobin casts in renal biopsies:https://www.ncbi.nlm.nih.gov/pubmed/?term=27038680.