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Case Report
Necrotizing myopathy as paraneoplastic disorder in tonsillar squamous cell carcinoma
1 Department of Neurology, University of Texas Medical Branch, Galveston Texas, USA
2 Department of Pathology, University of Texas Medical Branch, Galveston Texas, USA
3 Department of Internal Medicine, University of Texas Medical Branch, Galveston Texas, USA
Address correspondence to:
Bhanu Gogia
University of Texas Medical Branch, Galveston, Texas 77555,
USA
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Article ID: 101018Z01BG2019
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How to cite this article
Gogia B, Rai P, Gelman BB, Jazebi N, Reinertson RC, Patel K. Necrotizing myopathy as paraneoplastic disorder in tonsillar squamous cell carcinoma. Int J Case Rep Images 2019;10:101018Z01BG2019.ABSTRACT
Introduction: Myositis including polymyositis and dermatomyositis has been reported in different types of cancer mainly lung, breast and ovarian cancer.
Case Report: We report a case of necrotizing myopathy presenting in a 59-year-old patient after a recent diagnoses of squamous cell carcinoma of the tonsil. Three weeks later, the patient was admitted for worsening generalized weakness, dysphagia and constipation. Patient was bed bound requiring full assistance. Physical examination was significant for symmetrical weakness in his proximal muscle groups of upper and lower extremity. Creatinine kinase (CK) was 13,000 U/L with markedly elevated liver enzymes. EMG showed myotonia in all muscle groups with more prominence in axial and proximal muscles than distal. Following the biopsy of biceps muscle, IV steroid was initiated. IVIG was started later in addition to oral steroids due to suboptimal response. In the interim, biopsy showed severe necrotizing myopathy. Myositis Ab panel and paraneoplastic antibody panel including voltage gated potassium channel (VGPC) Ab, ANNA-1, ANNA-2 and PCA-1 Abs were negative. CK trended down to 1196 U/L after three weeks of steroids with moderate improvement in the muscle weakness.
Conclusion: Necrotizing myopathy can be associated with squamous cell carcinoma of tonsil. Serology may be negative and the presence of diffuse myotonia suggests myopathy. However, biopsy shows myofibers undergoing myophagocytosis with minimal inflammatory cells thus confirming necrotizing myopathy.
Keywords: Myotonia, Necrotizing myopathy, Paraneoplastic myopathy, Squamous cell carcinoma of tonsil
SUPPORTING INFORMATION
Author Contributions
Prashant Rai - Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Bhanu Gogia - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Benjamin B. Gelman - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Noushin Jazebi - Revising it critically for important intellectual content, Final approval of the version to be published
Randal C Reinertson - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Kamakshi Patel - Substantial contributions to conception and design, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2019 Bhanu Gogia et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
