A 65-year-old woman presented with a 5-week history of generalized weakness and myalgia. She had a history of seropositive myasthenia gravis post thymectomy for invasive thymoma and was in pharmacologic remission on prednisone and methotrexate. Although limited by significant pain, examination showed diffuse proximal and distal weakness. Serum creatine kinase (CK) was 572 IU/L. Myositis antibody panel was negative. MRI of her left extremities showed patchy muscle edema and inflammation (figures 1 and 2). Given the history of myasthenia gravis and thymoma, diagnosis of granulomatous myositis was made.1 Increased doses of prednisone and methotrexate resulted in resolution of pain and weakness and normalization of CK levels (51 IU/L).
Footnotes
Author contributions: Tim Tien Lai: drafting and revising the manuscript, acquisition of figures. Tahseen Mozaffar: drafting and revising the manuscript, study concept or design, interpretation of data.
Study funding: No targeted funding reported.
Disclosures: T.T. Lai reports no disclosures. T. Mozaffar serves on medical and scientific advisory boards for the Myositis Association, Genzyme Genetics, Idera Pharmaceuticals, and Ultragenyx; received travel reimbursement for advisory board meetings from Genzyme Corporation, Biomarin, and Amicus; has consulted for Amicus, Biomarin, Genzyme, Sarepta, and Ultragenyx; and received research support from Alnylam, Alexion, Amicus, Biomarin, CSL, Genzyme, ISIS, GSK, Novartis, Ultragenyx, and NIH. Go to Neurology.org/nn for full disclosure forms. The Article Processing Charge was paid by the authors.
- Received April 21, 2015.
- Accepted in final form April 28, 2015.
- © 2015 American Academy of Neurology
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially.
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