A case of necrotizing myopathy with proximal weakness and cardiomyopathy

• Published in: Neurology Vol. 78; no. 19; pp. 1527 - 1532
• Main Authors: MATTHEWS, E, PLOTZ, P. H, PORTARO, S, PARTON, M, ELLIOTT, P, HUMBEL, R. L, HOLTON, J. L, KEEGAN, B. M, HANNA, M. G
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 08-05-2012
• Subjects: Age; Arthralgia; Atrophy; Beverages; Biological and medical sciences; Cardiomyopathies - pathology; Cardiomyopathy; Dietary supplements; Diseases of striated muscles. Neuromuscular diseases; Dysphagia; Exanthema; Fatigue; Growth hormone; High protein diet; Humans; Limbs; Male; Medical sciences; Muscle Weakness - pathology; Muscles; Muscular Diseases - pathology; Myoglobinuria; Myopathy; Neurologic Examination; Neurology; quadriceps muscle; sphincter; Steroid hormones; Vitamins; Young Adult; Cardiovascular disease; Nervous system diseases; Cardiomyopathy; Myocardial disease; Heart disease; Myopathy
• ISSN: 0028-3878; 1526-632X
• DOI: 10.1212/WNL.0b013e3182553baa

CASE PRESENTATION A male amateur body builder presented at age 23 years with a 2-year history indicative of progressive proximal limb weakness. His initial symptom was a rash which was nonpruritic and he described as "ring" lesions on his trunk which spontaneously resolved after 6 months. Following resolution of the rash he developed a flu-like illness which was accompanied by chronic fatigue, poor appetite, and proximal limb weakness. In an attempt to counteract the muscle weakness and continue his usual rigorous weight training program, he began taking oral nandrolone decanoate and a high protein diet supplemented with creatine drinks and vitamin supplements for a 6-month period. However, over the next 18 months the proximal limb strength and his ability to lift weights continued to decline significantly. He noted progressive loss of muscle bulk in a proximal limb distribution. He restarted his steroid use and began injecting nandrolone decanoate, Sustanon, and testosterone propionate into his quadriceps, left deltoid, and glutei, in addition to oral anabolic steroids. When these failed to prevent further deterioration, he procured intramuscular injections of growth hormone. In addition to the proximal limb weakness and muscle atrophy, he complained of mild dysphagia, but this was nonprogressive. He reported no dysarthria, ptosis, or diplopia. He did not give any history of further rash and did not have any arthralgia, sensory symptoms, episodes to suggest myoglobinuria, or sphincter disturbance.