Contributed by David Lacomis, M.D.
A 32-year-old woman with anorexia nervosa and depression developed severe weakness, fatigue, and myalgias over several weeks. She had proximal more than distal weakness and dysphagia with nasal regurgitation. She became unable to walk. Sensation and tendon reflexes were unimpaired.
She had a diarrheal illness six weeks prior to the onset of weakness. Her anorexia nervosa had been stable but recently became problematic. There was no rash. She was on no medications. There was no weakness in the past nor was there a family history of neuromuscular disorders.
Serum creatine kinase (CK) was elevated 15-fold. ESR was normal; ANA was negative. Liver transaminases were mildly elevated. An electromyogram was consistent with myopathy. No fibrillation potentials that would suggest muscle necrosis or inflammation were noted. EKG was normal.