Progressive generalised w...

A 33-year-old man with gradual onset progressive generalised weakness, muscle stiffness and fatigue for one year, worsening over the previous month, was referred to the hospital. The patient had a history of tick bites, family history of hypothyroidism. Alcohol consumption was only moderate. Upon examination, the patient had highly developed upper body musculature, including bilateral prominence of temporalis muscles as shown in figure.

Physical examination, including neurological examination, was regular. Initial blood investigations showed average complete blood count, C reactive protein, electrolytes and liver biochemistry. However, the serum creatinine and urea levels were elevated. Chest X-ray, ECG, Urinalysis and Renal ultrasound scan showed normal. Viral screening and autoantibody screening were negative.

A final diagnosis of hypothyroid myopathy with rhabdomyolysis and acute renal injury was made. The patient was started on appropriate management. At outpatient review six weeks later, his symptoms had improved. In addition, the previously noted temporalis muscle hypertrophy had fully resolved by 24 weeks, as shown in the figure.