Case History:
A 72 year-old man presented to the Emergency Department with a 6-week history of progressive proximal symmetric muscle weakness. He noted some difficulty rising from a seated position, climbing stairs, and lifting up his arms to ninety degrees independently. He had no difficulty chewing, talking, swallowing, or opening and closing his eyes. He had diffused joint pain including in his proximal muscle groups in both limb girdles. He had no rash on his face, chest, back, hands, or on his eyelids. One week prior to this presentation, he was diagnosed with left lung basal pneumonia and treated with oral antibiotics. He had fatigue, malaise, night sweats, and dyspnea on exertion. He did not have abdominal pain, change in bowel habits, or black or bloody stools. He did not have dysuria, difficulty voiding, or hematuria. At the time of admission, he was on metoprolol succinate 50 mg daily, furosemide 20 mg daily, and aspirin 81 mg daily. He had been on atorvastatin and sacubitril-valsartan for a number of years, but these medications had been discontinued at the onset of his muscle weakness.
He has paraoesophageal hiatal hernia, Grover’s disease, dyslipidemia, hypertension, coronary artery disease, heart failure, and atrial fibrillation. His mother had been diagnosed with dermatomyositis at the age of 72.
His initial vital signs were normal. He had muscle atrophy in shoulder and hip muscles, but no atrophy was noted in finger flexors. No muscle tremors or fasciculations were observed. His right upper extremity muscle power was 3/5, and 2/5 strength in the left upper extremity. The power in his left and right hip flexors was 2/5. He had 5/5 power in his hands and fingers. His deep tendon reflexes were normal. The nail and nailfold capillaroscopy examination was normal. His joint, pulmonary, and abdominal examinations were normal.