A 55-year-old man presented with four-year history of progressive muscle wasting and weakness. His medical history disclosed advanced stage silicosis. The examination revealed flaccid quadriparesis with proximal amyotrophy. Serum creatine-kinase levels and screening for metabolic and inflammatory disorders were unremarkable. Muscle biopsy showed myopathic findings and the presence of abnormal amorphous and heterogeneous intracytoplasmic and subsarcolemmal content (Figure).
Chest CT-scan and muscle biopsy findings in silicosis. (A, B) Axial chest CT-scan showing bilateral severe advanced stage interstitial lung disease with marked lung architectural distortion (black arrow). Deltoid muscle biopsy showing abnormal subsarcolemmal and intracytoplasmic content disclosed in red in trichrome Gomori stain (C-E; white arrow) and black in NADH-TR histochemistry (F-H; white arrow-head).
Toxic myopathies can result from environmental and occupational exposure to toxic agents11. Dalakas MC. Toxic and drug-induced myopathies. J Neurol Neurosurg Psychiatry. 2009;80(8):832-8. https://doi.org/10.1136/jnnp.2008.168294
https://doi.org/10.1136/jnnp.2008.168294...
. Silicosis results from the deposition of crystalline silicon dioxide (silica) in lung and is associated with different systemic involvement, including osteoporosis, susceptibility to autoimmune disorders, constrictive pericarditis22. Leung CC, Yu ITS, Chen W. Silicosis. Lancet. 2012;379(9830):2008-18. https://doi.org/10.1016/S0140-6736(12)60235-9
https://doi.org/10.1016/S0140-6736(12)60...
and, rarely, myopathy.
References
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1Dalakas MC. Toxic and drug-induced myopathies. J Neurol Neurosurg Psychiatry. 2009;80(8):832-8. https://doi.org/10.1136/jnnp.2008.168294
» https://doi.org/10.1136/jnnp.2008.168294 -
2Leung CC, Yu ITS, Chen W. Silicosis. Lancet. 2012;379(9830):2008-18. https://doi.org/10.1016/S0140-6736(12)60235-9
» https://doi.org/10.1016/S0140-6736(12)60235-9
Publication Dates
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Publication in this collection
Jan 2018
History
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Received
15 Feb 2017 -
Accepted
04 Oct 2017