Available online at www.sciencedirect.com
ScienceDirect Neuromuscular Disorders 25 (2015) 94–95 www.elsevier.com/locate/nmd
Picture of the Month
Internalized capillaries in skeletal muscle biopsy Andreas Hawlik, Anette Wassner, Albert C. Ludolph, Jan Lewerenz, Angela Rosenbohm * Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany Received 30 May 2014; received in revised form 21 July 2014; accepted 22 August 2014
Keywords: Internalized capillary; Neuromyopathy with internalized capillaries; Skeletal muscle; Myalgia
Fig. 1. Routine muscle biopsy staining from calf muscle with internalized capillaries. a/b, hematoxylin eosin staining; c, elastica van Gieson; d, ATPase pH 4.6.
This 39-year-old male presented with a one-year history of chronic myalgia, especially in the calves. Myalgia was not related to physical activity but occurred in the evenings at rest after working in an upright position. Myoglobinuria never occurred. He reportedly experienced infrequent calf cramps starting several years ago. He reported doing frequent cycling and other physical activities for up to 6 hours per week. Creatin
* Corresponding author. Oberer Eselsberg 45, 89081 Ulm, Germany. Tel.: +49 731 177 5216; fax: +49 731 177 1202. E-mail address: [email protected]
(A. Rosenbohm). http://dx.doi.org/10.1016/j.nmd.2014.08.005 0960-8966/© 2014 Elsevier B.V. All rights reserved.
kinase was 239 U/l (normal range