Anesthesiologists have been at the forefront of initiatives addressing perioperative patient safety. As anesthesia has no direct therapeutic benefit, its risk must be minimized. At times the surgery is simple but the patient’s condition complicates anesthetic management, increasing the risk for complications. This report describes the anesthetic management of an adult patient diagnosed with inclusion body myositis (IBM), a rare inflammatory degenerative myopathy, who initially presented with decreased motor function in both lower and upper extremities causing him to be bedbound for two years. Due to the progression of his disease, he eventually developed dysphagia, hence he was scheduled for esophagoscopy, cricopharyngeal Botox injection, and percutaneous endoscopic gastrostomy. As patients with IBM are at risk for exaggerated sensitivity to neuromuscular blockers and respiratory compromise, anesthesia was at the helm of a multidisciplinary team approach. The perioperative management centered on preoperative optimization, prevention of aspiration, avoidance of anesthetics that may trigger malignant hyperthermia, and prevention of postoperative pulmonary complication. The hospital course was uncomplicated and the patient was discharged well after one day. This report emphasizes how improvements in resources, technology, and healthcare delivery, especially in anesthesia, help prevent perioperative adverse events.
Patient Safety ; Myositis, Inclusion Body ; Malignant Hyperthermia

Inclusion body myositis (IBM) is a chronic inflammatory myopathy with characteristic rimmed vacuoles. Cytoplasmic and intranuclear filamentous inclusions in muscle speci men. The clinical features manifest male dominance with the onset between the second and eighth decade but usually after the age of 50 years. Slow progression of painless muscle weakness, normal or mildly elevated serum CK level, myopathic and neurogenic eIectromyographic patterns and refractory to steriod therapy. The presence of rimmed vacuoles and filamentous inclusions in myofiber gives an important clue in the diagnosis of IBM, however, it is very difficult to differentiated young age onset IBM with distally predominant muscle weakness from distal myopathy with rimmed vacuole formation. While we present a young female patient who had slow progression of painless distal muscle weakness in both upper and lower extremities for 1 year, previously published articles concerning of IBM and distal myopathy with rimmed vacuole formation are reviewed and our own differential points are discussed in the diagnosis of this case as IBM.
Cytoplasm ; Diagnosis ; Distal Myopathies ; Female ; Humans ; Inclusion Bodies* ; Lower Extremity ; Male ; Muscle Weakness ; Muscular Diseases* ; Myositis ; Myositis, Inclusion Body* ; Vacuoles

Here we report a case of the classical inclusion body myositis. The muscle pathology in a 61-year-old male patient with slowly progressive proximal muscle weakness and atrophy revealed basophilic rimmed vacuoles on light microscope and intracytoplasmic filamentous inclusions with membranous whorls through electron microscope. He did not respond to steroid therapy.
Atrophy ; Basophils ; Humans ; Inclusion Bodies* ; Male ; Middle Aged ; Muscle Weakness ; Myositis, Inclusion Body* ; Pathology ; Vacuoles

In 1971 inclusion body myositis was reported by Yunis and Samaha. This disease is similar with chronic multiple myositis clinically. Pathologically, inclusion body myositis is characterized by intracytoplasmic vacuole with degenerating fibers and accompanied with inclusion body in internal nucleus and cytoplasm. Since then 240 cases of inclusion body myositis have been reported in the world including 3 cases in Korea. A 27 years-old lady had inclusion body myositis, which show slowly progressive muscular weakness. We confirmed this with clinical symptom, muscle biopsy, and electrophysiologic study. We report the typical manifestation of inclusion body myositis in a 27 years-old lady with the brief review of literature.
Adult ; Biopsy ; Cytoplasm ; Humans ; Inclusion Bodies* ; Korea ; Muscle Weakness ; Myositis, Inclusion Body* ; Polymyositis ; Vacuoles

Inclusion body myositis is a rare myopathy that clinically resembles a chronic polymyositis and histopathologically is characterized by the presence of rimmed vacuoles containing ultrastructural cytoplasmic degradation products with filamentous intranuclear and cytoplasmic inclusions. Since clinical features are not uniform, histopathologic and ultrastructural studies are necessary to confirm the diagnosis. We report a typical case of inclusion body myositis with histopathologic and ultrastructural study. The patient was a 31 year old male who presented with progressive weakness of both forearms, hands and lower extremities for 10 years.
Adult ; Case Report ; Human ; Male ; Muscles/pathology ; Myositis, Inclusion Body/*pathology/physiopathology

Inflammatory myopathies are comprised of three major subsets, polymyositis, dermatomyositis and inclusion body myositis. Although their etiology is unclear, each group retains its characteristic clinical, immunopathologic features. In polymyositis, a CD8+ T-cell mediated cytotoxicity against muscle fibers has emerged as the main pathologic event, whereas in dermatomyositis complement-mediated injury by antibody may be the primary pathology. There has been several reports on polymyositis internationally but we could find only a few reports in Korea. We report here a 8-year old female patient admitted with a stuporous mentality. After coughing and fever for 3 days, she got myalgia, abruptly developed gross hematuria and dyspnea. After admission, she showed weak self respiration and exclussively elevated muscle enzyme in blood chemistry. In muscle biopsy, lymphocytic infiltrations were found in the fascicles without endomysial fibrosis and these lymphocytes were composed of T lymphocytes on immunohistochemical stain. She received two infusions of intravenous immunoglobulin(1g/kg/day), and showed dramatic improvement in symptoms and signs.
Biopsy ; Chemistry ; Child ; Cough ; Dermatomyositis ; Dyspnea ; Female ; Fever ; Fibrosis ; Hematuria ; Humans ; Immunoglobulins* ; Korea ; Lymphocytes ; Myalgia ; Myositis ; Myositis, Inclusion Body ; Pathology ; Polymyositis* ; Respiration ; Stupor ; T-Lymphocytes

Inflammatory myopathies are comprised of three major subsets, polymyositis, dermatomyositis and inclusion body myositis. Although their etiology is unclear, each group retains its characteristic clinical, immunopathologic features. In polymyositis, a CD8+ T-cell mediated cytotoxicity against muscle fibers has emerged as the main pathologic event, whereas in dermatomyositis complement-mediated injury by antibody may be the primary pathology. There has been several reports on polymyositis internationally but we could find only a few reports in Korea. We report here a 8-year old female patient admitted with a stuporous mentality. After coughing and fever for 3 days, she got myalgia, abruptly developed gross hematuria and dyspnea. After admission, she showed weak self respiration and exclussively elevated muscle enzyme in blood chemistry. In muscle biopsy, lymphocytic infiltrations were found in the fascicles without endomysial fibrosis and these lymphocytes were composed of T lymphocytes on immunohistochemical stain. She received two infusions of intravenous immunoglobulin(1g/kg/day), and showed dramatic improvement in symptoms and signs.
Biopsy ; Chemistry ; Child ; Cough ; Dermatomyositis ; Dyspnea ; Female ; Fever ; Fibrosis ; Hematuria ; Humans ; Immunoglobulins* ; Korea ; Lymphocytes ; Myalgia ; Myositis ; Myositis, Inclusion Body ; Pathology ; Polymyositis* ; Respiration ; Stupor ; T-Lymphocytes

Rigid spine syndrome (RSS) is a childhood onset muscle disorder characterized by: marked limitation of motility of cervical and lumbar spine with severe lordosis, contracture of limb joints, mild and nonprogressive proximal muscle weakness, moderately elevated muscle enzymes, myopathic electromyographic patterns, and histological features of nonspecific myopathies. Here we present a 14-year-old girl with distinctive clinical features of rigid spine syndrome. She developed slowly progressive difficulty on walking because of joint contracture and rigid spine with severe lordosis since 4 years of age. There was mild but generalized muscle weakness. The serum creatine kinase was increased up to 743 IU/ml and the EMG studies showed combined features of myopathy and neuropathy. The muscle biopsy of vastus lateralis revealed the typical findings of rimmed vacuolar myopathy with perivascular inflammatory cell infiltration, which were consistent with the inclusion body myositis.
Adolescent ; Animals ; Biopsy ; Contracture ; Creatine Kinase ; Extremities ; Female ; Humans ; Joints ; Lordosis ; Muscle Weakness ; Muscular Diseases* ; Myositis, Inclusion Body ; Quadriceps Muscle ; Spine* ; Walking

Becker muscular dystrophy is a X-linked recessive disease with the affected gene at locus Xp21, characterized by progressive muscular weakness. Without the definite family history, it has been known that the diagnosis of this disease is almost impossible on clinical grounds alone. We reviewed the muscle pathology of two casses of genetically confirmed Becker muscular dystrophy to know the diagnositc significances of this study. The first case, a 20 year old man, is the classical one with definite family history of X-linked recessive heredity. The muscle pathology of the biceps showed dystrophic muscular changes, including increased internal nuclei, marked variation of fiber sizes and mild endomysial fibrosis. The dystrophin stain of the muscle was also confirmative for the diagnosis. The second case was a 32 year old man who has been biopsied his left vastus lateralis 5 years before this genetic diagnosis. This case is a sporadic one without the family history. The diagnosis at the time of muscle biopsy was limb-girdle muscular dystorphy or inclusion body myositis because of the typical rimmed vacuoles and marked variation of fiber sizes. The dystophin stain was not available at that time. Our conclusion is that the molecular genetic study and/or dystrophin protein test of muscle biopsy should be done in every clinically suspected patient, including limb-girdle muscular dystorphy, inclusion body myositis or rimmed vacuolar myopathies.
Adult ; Biopsy ; Diagnosis ; Dystrophin ; Fibrosis ; Heredity ; Humans ; Incontinentia Pigmenti* ; Molecular Biology ; Muscle Weakness ; Muscular Diseases ; Muscular Dystrophy, Duchenne ; Myositis, Inclusion Body ; Pathology ; Quadriceps Muscle ; Vacuoles ; Young Adult

We describes a patient with hypokalemia-induced rhabdomyolysis due to primary aldosteronism (PA), who suffered from slowly progressive muscle weakness after laparoscopic adrenalectomy, and was later diagnosed with coexisting sporadic inclusion body myositis (sIBM). A 54-year-old Asian male presented with severe muscle weakness of both lower extremities. Laboratory findings showed profound hypokalemia, and extreme elevation of the serum creatine phosphokinase levels, suggestive of hypokalemia-induced rhabdomyolysis. Further evaluation strongly suggested PA by an aldosterone-producing adenoma, which was successfully removed surgically. However, muscle weakness slowly progressed one year after the operation and a muscle biopsy demonstrated findings consistent with sIBM. This case is the first report of hypokalemia-induced rhabdomyolysis by PA coexistent with sIBM, to the best of our knowledge.
Adenoma ; Adrenalectomy ; Asian Continental Ancestry Group ; Biopsy ; Creatine Kinase ; Humans ; Hyperaldosteronism* ; Hypokalemia ; Lower Extremity ; Male ; Middle Aged ; Muscle Weakness ; Myositis, Inclusion Body* ; Rhabdomyolysis*