7. December 2012
◦ CPK: 2625
◦ EMG: Myogenic
◦ NCV: Axonal neuropathy
◦ Nerve biopsy: Chronic multifocal axonopathy with
sparse inflammation – possible vasculitis
◦ Muscle biopsy: Suggestive of possible inflammatory
myositis
◦ TSH: 8.18 mic IU/ml
◦ Vasulitis profile -ve
8.
9. Discharged on 13/01/13
Pulse Cyclophosphamide first dose (1.18g x 3 d)
Plasmapharesis - patient could not tolerate.
IVIG - could not afford
Prednisolone 50 mg daily
IV Methyl Prednisolone x 7 days
Diagnosed- Inflammatory Neuromyopathy.
Dx & Rx at NIMHANS
10. Worsening of Quadriplegia (Proximal+ Distal)
with dysphagia
Generalized edema over the extremities.
Erythematous rashes all over her body.
11. LFT : Enzymes raised
↑ TC
CPK (489 U/L)
X Ray Chest- Right lung consolidation
Viral markers: HIV, HCV, HBsAg, -ve
13. At 7 am, 07/02/13 (Day 2), suddenly became
unresponsive with hypotension, and
bradycardia
She was immediately intubated & ventilated
and shifted to ICU.
Ionotropic support was provided.
5pm Died
14. Ms MB 42/f presented with progressive
Neuromyositis with Low B12, and mildly
raised TSH over 5months, unresponsive to
immuno-suppression.
21. • This case was suffering from rapidly
progressive Neuromyositis (inflammatory)
with negative vasculitis and connective tissue
disorder profile
• Possible Differential Diagnosis
1. Anti SRP positive polymyositis with
cardiomyopathy
2. ANCA negative polyarteritis nodosa
3. Paraneoplastic neuromyositis