Mycophenolate mofetil induced myopathy in a patient with lupus nephritis.
We describe a case of mycophenolate mofetil (MMF) induced myopathy in a patient with lupus nephritis. Two months after starting MMF treatment she developed asthenia, lower limb weakness, and abnormal increase of muscle enzymes. An electromyogram showed a myogenic pattern with small polyphasic discharges without neurogenic signs involving proximal muscles of lower limbs. Muscle biopsy revealed the presence of fibers of variable size with irregular sarcoplasmic basophilic areas. Using oxidative enzyme techniques, many type I fibers showed a moth-eaten appearance resembling minicores. The ultrastructural findings consisted of myofibrillary lesions with multiple small foci of Z-band streaming. MMF withdrawal was followed by complete clinical and enzymatic recovery.
Galindo
María
M
Rheumatology Unit, Hospital 12 de Octubre, Madrid, Spain. reuma@h12o.es
Cabello
Ana
A
Joven
Beatriz
B
Alonso
Ana
A
Carreira
Patricia
P
Porta
Jesús
J
Ricoy
José Ramón
JR
Mateo
Isabel
I
Pablos
José L
JL
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001706:Biopsy; D004576:Electromyography; D005260:Female; D006801:Humans; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000473:pathology; D018482:Muscle, Skeletal / Q000503:physiopathology / Q000648:ultrastructure; D009135:Muscular Diseases / Q000139:chemically induced* / Q000473:pathology / Q000503:physiopathology; D009173:Mycophenolic Acid / Q000009:adverse effects* / Q000031:analogs & derivatives*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D009173:Mycophenolic Acid