title: Myalgia as the revealing symptom of multicore disease and fibre type disproportion myopathy.
abstract: BACKGROUND
  Multicore disease and congenital fibre type disproportion myopathy are diseases assigned to the heterogeneous group of congenital myopathies. Although hypotonia and muscle weakness appearing in early life are the commonest manifestations of these diseases, distinct phenotypes and late onset cases have been described.
  
  
  OBJECTIVE
  To report the occurrence of myalgia as the revealing symptom of multicore disease and fibre type disproportion myopathy.
  
  
  METHODS
  The clinical cases of three patients with fibre type disproportion myopathy and one with multicore disease are described. Skeletal muscle biopsies were processed for routine histological and histochemical studies.
  
  
  RESULTS
  The clinical picture was unusual in that the symptoms were of late onset and the predominant complaint was muscle pain exacerbated by exercise. Muscle weakness was found in only a single patient, the mother of a patient with fibre type disproportion myopathy. Physical examination was unremarkable in the other patients. Muscle biopsies from patients 1 and 2 contained type I fibres that were considerably smaller than the type II fibres, supporting the diagnosis of fibre type disproportion myopathy. Skeletal muscle of patient 4 showed multiple areas, predominantly but not exclusively in the type I fibres, from which oxidative enzyme activities were absent, as seen in multicore disease.
  
  
  CONCLUSIONS
  Muscle pain was the main clinical manifestation in our patients. Recognition of the broader clinical expression of these myopathies is important for prognostic reasons and for genetic counselling of the family members.
authors.affiliation: Departamento de Neurologia, Psiquiatria e Psicologia Médica, Universidade de São Paulo, Brazil. csobreira@rnp.fmrp.usp.br
authors.forename: C
authors.initials: C
authors.lastname: Sobreira
authors.forename: W
authors.initials: W
authors.lastname: Marques
authors.forename: A A
authors.initials: AA
authors.lastname: Barreira
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018485:Muscle Fibers, Skeletal / Q000473:pathology*; D018908:Muscle Weakness / Q000209:etiology; D018482:Muscle, Skeletal / Q000473:pathology*; D020512:Myopathy, Central Core / Q000150:complications* / Q000175:diagnosis; D010146:Pain / Q000209:etiology*; D010641:Phenotype; D011379:Prognosis