Clinical Problem Solving: An Older Woman With Weakness from Head to Toe

David A Hartmann; Meredith Bock; Vanja Douglas; Josiah Gerdts; Biswarathan Ramani; Maulik Shah

doi:10.1177/19418744211005321

Clinical Problem Solving: An Older Woman With Weakness from Head to Toe

Neurohospitalist. 2022 Jan;12(1):177-182. doi: 10.1177/19418744211005321. Epub 2021 Apr 16.

Authors

David A Hartmann¹, Meredith Bock², Vanja Douglas², Josiah Gerdts², Biswarathan Ramani³, Maulik Shah²

Affiliations

¹ Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
² Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
³ Department of Neuropathology, University of California San Francisco, San Francisco, CA, USA.

Abstract

A 67-year-old woman was admitted to our hospital for progressive weakness, dysphagia, muscle pain, and weight loss. Here we detail the clinical problem solving involved in diagnosing and treating her immune-mediated necrotizing myopathy caused by anti-HMGCoA reductase autoantibodies. Interestingly, this diagnosis coincided with discovery of a gastrointestinal stromal tumor (GIST) and positivity for anti-nuclear matrix protein (anti-NXP2), another myositis specific autoantibody.

Keywords: autoimmune diseases of the nervous system; clinical specialty; education; muscular diseases; myositis; neuromuscular disease; neuromuscular diseases; techniques.