title: A heroin addict with focal weakness.
abstract: A 24-year-old female with 5 year history of heroin abuse experienced painless stiffness of elbow joints and weakness of shoulder and upper limb muscles. She was injecting herself 4-6 times daily alternatively in the upper extremities, sparing the lower limbs. Electromyography (EMG) showed myopathic changes in clinically affected and unaffected muscles. Magnetic resonance imaging (MRI) revealed muscle fibrosis in directly injected muscles, whereas in subcutaneous fat and within muscles of anterior and posterior compartments of both thighs, not directly injected, there were signal changes supportive of oedema and inflammation. EMG and MRI were congruent in showing abnormalities in muscles not directly injected, suggesting long distant effects of heroin or adulterants with a mechanism either toxic or immunologically mediated.
authors.affiliation: Department of Neurosciences, University Hospital, Modena, Italy. giulianagalassi@aliceposta.it
authors.forename: Giuliana
authors.initials: G
authors.lastname: Galassi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Ariatti
authors.forename: Manuela
authors.initials: M
authors.lastname: Gozzi
authors.forename: Stefano
authors.initials: S
authors.lastname: Cavazza
mesh_terms: D003937:Diagnosis, Differential; D004576:Electromyography; D005260:Female; D005355:Fibrosis / Q000175:diagnosis / Q000209:etiology; D006556:Heroin Dependence / Q000150:complications*; D006801:Humans; D008279:Magnetic Resonance Imaging; D018482:Muscle, Skeletal / Q000473:pathology* / Q000503:physiopathology; D009135:Muscular Diseases / Q000175:diagnosis / Q000209:etiology*; D055815:Young Adult
keywords: Heroin myopathy; focal myopathy; muscle fibrosis