Reversible emetine-induced myopathy with ECG abnormalities: a toxic myopathy.
A young anorexic woman is described with a history of progressive muscle weakness following chronic ingestion of syrup of ipecac that was used in an attempt at weight control. Electrocardiogram (ECG) showed T-wave inversion in all leads and prolongation of the Q-T interval. Electromyography was abnormal. Muscle biopsy revealed a randomized, generalized, predominantly type-2 fibre atrophy and structural alterations in oxidative enzyme stains, such as targetoid and moth-eaten fibres. A few necrotic cells were actively phagocytosed. Electron microscopy revealed severe sarcomeric abnormalities with Z-line streaming, myofibrillar disorganization and increased lysosomal activity. After discontinuation of ipecac syrup, the patient noted a gradual improvement in her condition. The ECG became normal. Emetine and related drug-induced myopathies are uncommon but are of experimental interest because of their effects on mitochondria and the light they shed on autophagic mechanisms in muscle.
Kuntzer
T
T
Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Bogousslavsky
J
J
Deruaz
J P
JP
Janzer
R
R
Regli
F
F
D000328:Adult; D009202:Cardiomyopathies / Q000139:chemically induced; D004562:Electrocardiography; D004640:Emetine / Q000633:toxicity*; D005260:Female; D006801:Humans; D008854:Microscopy, Electron; D009132:Muscles / Q000648:ultrastructure; D009468:Neuromuscular Diseases / Q000139:chemically induced*; D013997:Time Factors
D004640:Emetine