Vacuolated myopathy: Biopsy of the patient’s deltoid muscle on a hematoxylin-eosin stain showing intracytoplasmic vacuoles.
Based on an article in JGIM in 2009 by Patel and DePriest.
A 66-year-old male presented with visual hallucinations. He had chronically elevated serum creatine kinase (CK) levels without muscle weakness. The patient had a two-year history of depression marked by decreased appetite, inability to concentrate and memory problems. He was diagnosed as having depression with psychotic features and was admitted to the inpatient psychiatry service for further evaluation. To evaluate the elevated CK levels a nerve conduction test / electromyography was done. This showed evidence of myopathy. On the fourth morning the patient was found to be acutely unresponsive, even to painful stimuli. He had shallow respirations at a rate of 14/min. Arterial blood gases (ABG) obtained showed a PCO2 of 116. He was intubated and sent to the intensive care unit (ICU) to be placed on mechanical ventilation. Four days after ICU admission the deltoid muscle and the sural nerve were biopsied and were sent for histopathological analysis. ‘vacuolated myopathy - probable acid maltase deficiency disorder’ (low acid maltase levels, 0.57 micromol/min/gram1.74-9.98, confirming the diagnosis of primary acid maltase deficiency. The patient received enzyme replacement therapy, and has shown clinical improvement. Since he has been on mechanical ventilation the patient’s visual hallucinations have completely resolved.
The answer to the question posed in the poll is mentioned in the original article by Patel and DePriest is available here
Learn How to Submit Here
Penny Shutt (Accompanying painting by Sohi Mistry) I hesitate at the doorway to your side-room, ....
(Accompanying painting by Sohi Mistry)
I hesitate at the doorway to your side-room, ....
The Role of Community-Based Participatory Research to Inform Local Health Policy:
A Case Study.
O’Brien, Matthew J.; Whitaker, Robert C.
Presyncope and a Cardiac Mass
Jorge Roman, B.S., Patrick T. Roughneen, M.D.
Bridges to the Island: The Abandonment of Addiction
Anant Shukla, MD
A Prescription for Kindness
Bui, Simonetti, Benson, Malek and Anderson
Dual Process Theory Overview
Reza Manesh, Denise M. Connor, Jeff Kohlwes
Incorporating Palliative Care Principles into the Care of the Older Adult with Hip Fracture | SGIM Forum https://t.co/nT80R97xuH
Follow SGIM on Twitter: @SocietyGIM
Follow SGIM on Facebook: SocietyGIM
Follow SGIM on: LinkedIn
Learn more about Apply for CME at sgim.org
Latino adults with diabetes who participated in a church-based education program reported eating less high-fat food and exercising more following a trial intervention program run by researchers from University...
© Society of General Internal Medicine | SGIM
1500 King Street Ste 303 Alexandria, VA 22314