Misdiagnosis of inclusion body myositis: two case reports and a retrospective chart review.
BACKGROUND
Sporadic inclusion body myositis is the most common adult myopathy in persons aged 50 years and older. The clinical presentation includes a chronic, slowly progressive course with a predilection for weakness of the forearm flexors and quadriceps muscles. Its indolent course makes it a disease frequently missed or misdiagnosed as other neuromuscular conditions by health care professionals. The degenerative processes with amyloid accumulation distinguish sporadic inclusion body myositis from other inflammatory myopathies. Currently, no effective therapy exists. This clinical report highlights the difficulties in diagnosing the disease, examples of misdiagnosis, and inappropriate therapies that can result from misdiagnosis.


METHODS
We present our clinical experience with 20 patients over a 10-year period and describe in depth two cases, both men, one of Indian ethnicity and the other of Hispanic ethnicity, who were referred to our neuromuscular division for second opinions and diagnosed with sporadic inclusion body myositis years after symptom onset.


CONCLUSIONS
Although sporadic inclusion body myositis is rare and without effective therapy, accurate diagnosis is crucial to providing adequate counseling and information about the prognosis and disease course, and to avoiding inappropriate therapy.
Neuromuscular Division, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 3000, Los Angeles, CA, 90033, USA. chilingamd@yahoo.com.
Amaiak
A
Chilingaryan
Keck School of Medicine, University of Southern California, Los Angeles County Medical Center, PIH Health Hospital-Whittier Stroke Program, 12401 Washington Boulevard, Whittier, CA, 90602, USA. rison@usc.edu.
Richard A
RA
Rison
Neuromuscular Division, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 3000, Los Angeles, CA, 90033, USA. sbeydoun@usc.edu.
Said R
SR
Beydoun
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016229:Amyloid beta-Peptides / Q000032:analysis; D000690:Amyotrophic Lateral Sclerosis / Q000175:diagnosis*; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology; D018979:Myositis, Inclusion Body / Q000175:diagnosis* / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies
D016229:Amyloid beta-Peptides