Held M, Schneider C, Fleischer K, Jany B
Abteilung für Innere Medizin, Missionsärztliche Klinik Würzburg.
Dtsch Med Wochenschr. 1998 Oct 9;123(41):1201-6. doi: 10.1055/s-2007-1024143.
A 36-year-old man reported feeling generally unwell and experiencing shooting and tearing pain, especially in the thighs and over the precordium, just after returning from a five-week holiday in Central Africa. An active sportsman in his youth (fencing) he was known to have incomplete right bundle branch block in the ECG and a raised concentration of gamma-glutamyl transferase, of unknown aetiology. Physical examination on admission was negative except for discrete weakness on head bending and slightly delayed finger stretching after making a fist.
Multiple tests excluded tropical diseases. There were abnormal T waves in leads III and V1 of the ECG. Serum concentrations of creatine kinase (CK; maximally 822 U/l), gamma-glutamyl transaminase (gamma-GT; 446 U/l), glutamyl-pyruvate transaminase (GPT; 510 U/l) and of glutamate-oxalate transaminase (GOT; 108 U/l) were all elevated. Erythrocyte sedimentation rate and C-reactive protein were within normal limits.
At first the suspected diagnosis was myocarditis and he was placed on bed-rest, monitored and treated symptomatically. Because the levels of CK, gamma-GT, GPT and GOT improved only transiently, there were no signs of inflammatory disease and the muscle pains continued, biopsies of skeletal muscle and the liver were done. They revealed nonspecific liver changes and a noninflammatory myopathy. As congenital myopathy was suspected he was transferred to the neurology department where the diagnosis of proximal myotonic myopathy (PROMM) was established.
We assume that an unknown viral infection triggered the illness that, in addition to the usual nonspecific symptoms, accentuated the signs of the existing multi-system proximal myotonic myopathy.
一名36岁男性报告称，在从中部非洲度过五周假期归来后，感觉全身不适，并经历刺痛和撕裂样疼痛，尤其是在大腿和心前区。他年轻时是一名活跃的运动员（击剑），已知心电图有不完全性右束支传导阻滞，γ-谷氨酰转移酶浓度升高，病因不明。入院时体格检查除头部弯曲时有离散性无力以及握拳后手指伸展稍延迟外，其余均为阴性。
多项检查排除了热带疾病。心电图III导联和V1导联出现异常T波。血清肌酸激酶（CK；最高822 U/L）、γ-谷氨酰转胺酶（γ-GT；446 U/L）、谷丙转氨酶（GPT；510 U/L）和谷草转氨酶（GOT；108 U/L）水平均升高。红细胞沉降率和C反应蛋白在正常范围内。
起初怀疑诊断为心肌炎，他被要求卧床休息，接受监测并进行对症治疗。由于CK、γ-GT、GPT和GOT水平仅短暂改善，无炎症性疾病迹象且肌肉疼痛持续，遂进行了骨骼肌和肝脏活检。活检显示肝脏有非特异性改变以及非炎性肌病。由于怀疑是先天性肌病，他被转至神经科，最终确诊为近端强直性肌病（PROMM）。
我们认为，一种未知的病毒感染引发了该疾病，除了常见的非特异性症状外，还加重了现有的多系统近端强直性肌病的体征。
