2000 Volume 43 Issue 8 Pages 695-700
We report 74-year-old male patient who had type 2 diabetes mellitus with the rare disease inclusion body myositis (IBM). The patient was diagnosed as having type 2 diabetes mellitus on 1979 (at 57 years of age). He was initially treated with an oral hypoglycemic agent, but his glycemic control gradually worsened. He began to notice muscle weakness in both legs in 1986. Although his glycemic control improved markedly after insulin administration, he was found to have elevated CK levels in 1994, and the elevated CK levels persisted along with exacerbated muscle weakness and atrophy in the legs. He was then rehospitalized on 1996 because of progressive muscle weakness of his legs, and the EMG findings, including denervation potentials, suggested diabetic amyotrophy. Because of the persistently elevated serum CK levels, a quadriceps muscle biopsy was performed. Histological examination of the muscle tissue showed advanced myopathic changes with inflammatory cellular infiltration, rimmed vacuoles and filamentous nuclear inclusions, which were the characteristic findings of IBM. Although the initial symptoms of IBM, including distal dominant muscle weakness, are similar to those of diabetic amyotrophy, their prognosis is very different, making the differential diagnosis of neuromusclar diabetic complications clinically important for patient follow-up.
