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.
Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
T
T
Kuntzer
J
J
Bogousslavsky
J P
JP
Deruaz
R
R
Janzer
F
F
Regli
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