Myopathy with thick filament (myosin) loss following prolonged paralysis with vecuronium during steroid treatment.
A 20-year-old female hospitalized with status asthmaticus was treated with bronchodilators, antibiotics, and high-dose corticosteroids, and was paralyzed with vecuronium for 10 days to facilitate mechanical ventilation. When this was discontinued, she was found to have a flaccid quadriplegia with areflexia and 4-fold elevation in serum creatine kinase. A muscle biopsy showed extensive loss of thick (myosin) myofilaments, sometimes in core-like distribution, with relative preservation of thin (actin) filaments and Z-discs. Muscle strength returned to normal after 2 months. The pathological lesion in this patient's muscle fibers resemble those in rats treated with high doses of corticosteroids following denervation.
Danon
M J
MJ
Department of Neurology, University of Illinois, College of Medicine, Chicago 60612.
Carpenter
S
S
D000328:Adult; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D008775:Methylprednisolone / Q000009:adverse effects*; D009132:Muscles / Q000737:chemistry / Q000648:ultrastructure; D009135:Muscular Diseases / Q000139:chemically induced* / Q000378:metabolism / Q000473:pathology; D009218:Myosins / Q000648:ultrastructure*; D010243:Paralysis / Q000139:chemically induced; D012121:Respiration, Artificial; D013224:Status Asthmaticus / Q000188:drug therapy / Q000628:therapy; D014673:Vecuronium Bromide / Q000009:adverse effects*
D014673:Vecuronium Bromide; D009218:Myosins; D008775:Methylprednisolone