Muscle weakness and Myoglobinuria: Difference between revisions

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__NOTOC__
{{CMG}}; {{AE}} {{IQ}}


==Differential Diagnosis of Muscle weakness and Myoglobinuria==
{|
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Organ system
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease
! colspan="12" style="background:#4479BA; color: #FFFFFF;" align="center" + |Symptoms
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |History
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical
Examination
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |Diagnosis
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Age of onset
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Muscle weakness
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Myalgia
! style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Contractures'''
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gait abnormality
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Neuropathy
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Atrophy
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Stiffness
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Myoglobinuria
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Other features
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Laboratory Findings
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Creatine Kinase
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Muscle Biopsy
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Electromyogram
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Medication−induced
! style="background:#DCDCDC;" align="center" + |[[Statins]]<ref name="pmid22001973">{{cite journal |vauthors=Tomaszewski M, Stępień KM, Tomaszewska J, Czuczwar SJ |title=Statin-induced myopathies |journal=Pharmacol Rep |volume=63 |issue=4 |pages=859–66 |date=2011 |pmid=22001973 |doi= |url=}}</ref>
| style="background:#F5F5F5;" align="center" + |60+
| style="background:#F5F5F5;" align="center" + |Proximal
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
| style="background:#F5F5F5;" align="center" + | −
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−/+([[Rhabdomyolysis]])
| style="background:#F5F5F5;" align="left" + |
* N/A
| style="background:#F5F5F5;" align="left" + |
*Positive h/o medications
*H/o other medication use
| style="background:#F5F5F5;" align="left" + |
* [[Tenderness]]
* Muscle aches
| style="background:#F5F5F5;" align="left" + |
* '''↑↑''' Liver enzymes
| style="background:#F5F5F5;" align="left" + |
* '''↑↑'''
| style="background:#F5F5F5;" align="left" + |
* [[Necrosis]]
* Degeneration, and regeneration of fibers
* Phagocytic infiltration
| style="background:#F5F5F5;" align="left" + |
* Normal
|-
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Endocrine
! style="background:#DCDCDC;" align="center" + |[[Hyperaldosteronism]] with myopathy<ref name="pmid5037033">{{cite journal |vauthors=Sambrook MA, Heron JR, Aber GM |title=Myopathy in association with primary hyperaldosteronism |journal=J. Neurol. Neurosurg. Psychiatry |volume=35 |issue=2 |pages=202–7 |date=April 1972 |pmid=5037033 |pmc=494037 |doi= |url=}}</ref>
| style="background:#F5F5F5;" align="center" + |50
| style="background:#F5F5F5;" align="center" + |Proximal<br>&<br>distal
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + | −
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
[[Rhabdomyolysis]]
| style="background:#F5F5F5;" align="left" + |
* [[Palpitations]]
* [[Hypertension]]
| style="background:#F5F5F5;" align="left" + |
* Episodes of [[Palpation|increased heart beats]]
| style="background:#F5F5F5;" align="left" + |
* [[Hyperpigmentation]]
| style="background:#F5F5F5;" align="left" + |
* [[Hypokalemia]]
| style="background:#F5F5F5;" align="left" + |
* Normal
| style="background:#F5F5F5;" align="left" + |
* Normal
| style="background:#F5F5F5;" align="left" + |
* Normal
|-
! style="background:#DCDCDC;" align="center" + |[[Hyperthyroidism]]<ref name="pmid28746208">{{cite journal |vauthors=Li Q, Liu Y, Zhang Q, Tian H, Li J, Li S |title=Myopathy in hyperthyroidism as a consequence of rapid reduction of thyroid hormone: A case report |journal=Medicine (Baltimore) |volume=96 |issue=30 |pages=e7591 |date=July 2017 |pmid=28746208 |pmc=5627834 |doi=10.1097/MD.0000000000007591 |url=}}</ref>
| style="background:#F5F5F5;" align="center" + |40
| style="background:#F5F5F5;" align="center" + |Proximal
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + | −
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
| style="background:#F5F5F5;" align="left" + |
* Signs of [[hyperthyroidism]]
| style="background:#F5F5F5;" align="left" + |
* H/o of [[weight loss]]
| style="background:#F5F5F5;" align="left" + |
* [[Sweating]]
* [[Tremor]]
* Neck swelling
| style="background:#F5F5F5;" align="left" + |
* Decreased [[TSH]]
| style="background:#F5F5F5;" align="left" + |
* '''↑↑'''
| style="background:#F5F5F5;" align="left" + |
* Non specific
| style="background:#F5F5F5;" align="left" + |
* [[Myotonic]]
|-
! style="background:#DCDCDC;" align="center" + |[[Hypothyroidism]]<ref name="pmid6627693">{{cite journal |vauthors=Khaleeli AA, Griffith DG, Edwards RH |title=The clinical presentation of hypothyroid myopathy and its relationship to abnormalities in structure and function of skeletal muscle |journal=Clin. Endocrinol. (Oxf) |volume=19 |issue=3 |pages=365–76 |date=September 1983 |pmid=6627693 |doi= |url=}}</ref>
| style="background:#F5F5F5;" align="center" + |55
| style="background:#F5F5F5;" align="center" + |Proximal
| style="background:#F5F5F5;" align="center" + | −
| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | + [[Rhabdomyolysis MRI|Rhabdomyolysis]]
| style="background:#F5F5F5;" align="left" + |
*  Signs of [[hypothyroidism]]
| style="background:#F5F5F5;" align="left" + |
* H/o [[weight gain]]
| style="background:#F5F5F5;" align="left" + |
* [[Myxedema|Myxoedema]] 
* Muscle pseudohypertrophy
| style="background:#F5F5F5;" align="left" + |
* Increased [[TSH]]
| style="background:#F5F5F5;" align="left" + |
* '''↑↑'''
| style="background:#F5F5F5;" align="left" + |
* Nonspecific 
| style="background:#F5F5F5;" align="left" + |
* Normal
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious
! style="background:#DCDCDC;" align="center" + |[[Influenza]]<ref name="pmid6687269">{{cite journal |vauthors=Bove KE, Hilton PK, Partin J, Farrell MK |title=Morphology of acute myopathy associated with influenza B infection |journal=Pediatr Pathol |volume=1 |issue=1 |pages=51–66 |date=1983 |pmid=6687269 |doi= |url=}}</ref>
| style="background:#F5F5F5;" align="center" + |Variable
| style="background:#F5F5F5;" align="center" + | Proximal and Distal
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
| style="background:#F5F5F5;" align="center" + | −
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
| style="background:#F5F5F5;" align="left" + |
* [[Fever]]
* [[Malaise]]
* [[Rhinorrhea]]
* [[Muscle pain]] worse with movement
| style="background:#F5F5F5;" align="left" + |
*Cold weather
*H/o Ill contacts
| style="background:#F5F5F5;" align="left" + |
* Muscle weakness, tenderness, and swelling.
| style="background:#F5F5F5;" align="left" + |
* '''↑↑''' Liver enzymes
* Positive PCR
| style="background:#F5F5F5;" align="left" + |
* '''↑↑'''
| style="background:#F5F5F5;" align="left" + |
* N/A
| style="background:#F5F5F5;" align="left" + |
* N/A
|}
==References==
{{Reflist|2}}
[[Category:Medicine]]
[[Category:Neurology]]
[[Category:Rheumatology]]
[[Category:Up-To-Date]]

Latest revision as of 22:48, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Differential Diagnosis of Muscle weakness and Myoglobinuria

Organ system Disease Symptoms History Physical

Examination

Diagnosis
Age of onset Muscle weakness Fever Myalgia Contractures Gait abnormality Neuropathy Atrophy Stiffness Myoglobinuria Other features Laboratory Findings Creatine Kinase Muscle Biopsy Electromyogram
Medication−induced Statins[1] 60+ Proximal − + − − − − − −/+(Rhabdomyolysis)
  • N/A
  • Positive h/o medications
  • H/o other medication use
  • ↑↑ Liver enzymes
  • ↑↑
  • Necrosis
  • Degeneration, and regeneration of fibers
  • Phagocytic infiltration
  • Normal
Endocrine Hyperaldosteronism with myopathy[2] 50 Proximal
&
distal 		− − − − − − − +

Rhabdomyolysis

  • Normal
  • Normal
  • Normal
Hyperthyroidism[3] 40 Proximal − − − − − + + +
  • ↑↑
  • Non specific
Hypothyroidism[4] 55 Proximal − + + − − + + + Rhabdomyolysis
  • ↑↑
  • Nonspecific 
  • Normal
Infectious Influenza[5] Variable Proximal and Distal + + − + − − − +
  • Cold weather
  • H/o Ill contacts
  • Muscle weakness, tenderness, and swelling.
  • ↑↑ Liver enzymes
  • Positive PCR
  • ↑↑
  • N/A
  • N/A

References

  1. ↑ Tomaszewski M, Stępień KM, Tomaszewska J, Czuczwar SJ (2011). "Statin-induced myopathies". Pharmacol Rep. 63 (4): 859–66. PMID 22001973.
  2. ↑ Sambrook MA, Heron JR, Aber GM (April 1972). "Myopathy in association with primary hyperaldosteronism". J. Neurol. Neurosurg. Psychiatry. 35 (2): 202–7. PMC 494037. PMID 5037033.
  3. ↑ Li Q, Liu Y, Zhang Q, Tian H, Li J, Li S (July 2017). "Myopathy in hyperthyroidism as a consequence of rapid reduction of thyroid hormone: A case report". Medicine (Baltimore). 96 (30): e7591. doi:10.1097/MD.0000000000007591. PMC 5627834. PMID 28746208.
  4. ↑ Khaleeli AA, Griffith DG, Edwards RH (September 1983). "The clinical presentation of hypothyroid myopathy and its relationship to abnormalities in structure and function of skeletal muscle". Clin. Endocrinol. (Oxf). 19 (3): 365–76. PMID 6627693.
  5. ↑ Bove KE, Hilton PK, Partin J, Farrell MK (1983). "Morphology of acute myopathy associated with influenza B infection". Pediatr Pathol. 1 (1): 51–66. PMID 6687269.
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