title: Rippling muscle syndrome preceding malignant lymphoma.
abstract: A 46-year-old woman presented with rippling muscle phenomenon. She complained of uncomfortable muscular stiffness of extremities and abdominal wall. Muscle contraction was easily elicited by percussion, which was visible from the surface and propagated in a rolling manner. The mounding (or myoedema) phenomenon was also remarkable. Three years later, malignant lymphoma (histologically, lymphoplasmacytoid lymphoma) was found in the sacrum. The lymphoma subsided with treatment by vincristine, cyclophosphamide, doxorubicin and prednisolone. Serum IgG as well as creatine kinase values were normalized. The rippling phenomenon also responded to the treatment. The present rippling muscle syndrome might be of a paraneoplastic or autoimmune origin related to lymphoma, although the evidence seemed indirect. We discussed the role of the internal membrane system of the skeletal muscle in the pathogenesis of rippling muscle.
authors.affiliation: Department of Neurology, Toranomon Hospital, Tokyo.
authors.forename: Akio
authors.initials: A
authors.lastname: Takagi
authors.forename: Susumu
authors.initials: S
authors.lastname: Kojima
authors.forename: Tomoji
authors.initials: T
authors.lastname: Watanabe
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Ida
authors.forename: Shouhei
authors.initials: S
authors.lastname: Kawagoe
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D004576:Electromyography; D006984:Hypertrophy; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D009101:Multiple Myeloma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D009119:Muscle Contraction; D018485:Muscle Fibers, Skeletal / Q000473:pathology; D018482:Muscle, Skeletal / Q000473:pathology; D009468:Neuromuscular Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D010257:Paraneoplastic Syndromes / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D011239:Prednisolone / Q000008:administration & dosage; D012021:Reflex, Abnormal; D012074:Remission Induction; D012447:Sacrum / Q000473:pathology*; D013125:Spinal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone