Chloroquine Myopathy
Identifieur interne : 003B54 ( Main/Exploration ); précédent : 003B53; suivant : 003B55Chloroquine Myopathy
Auteurs : J. Trevor Hughes [Royaume-Uni] ; Margaret Esiri [Royaume-Uni] ; J. M. Oxbury [Royaume-Uni] ; C. W. M. Whitty [Royaume-Uni]Source :
- QJM: An International Journal of Medicine [ 1460-2725 ] ; 1971.
Abstract
Two cases are described of chloroquine myopathy following prolonged courses of chloroquine given in one case for rheumatoid arthritis and in the other case for sarcoidosis. Skeletal muscles were severely affected but there was also clinical evidence in both cases of cardiac involvement and Case 1, in which there was histological evidence of cardiomyopathy, died of heart failure. Muscle biopsy in both cases and skeletal muscle at necropsy in Case 1 showed a striking vacuolar degeneration of about 50 per cent of the muscle-fibres. Histochemical examination showed that the granular (type I) muscle-fibres were preferentially affected. Electron microscopy showed the ultrastructural detail of the extensive degeneration of the muscle-fibres which contain large numbers of myelin figures thought to be a type of lysosome. There were mitochondrial changes which appear to precede the formation of the myelin figures. The literature of other clinical cases and of the experimentally produced myopathy is briefly reviewed. There is evidence that the administration of chloroquine for a long time in high dosage can cause a toxic myopathy. We record here two further cases. The first clinical report of human cases was made by Whisnant, Espinosa, Kierland, and Lambert (1963), but this side effect has been known in animals since the experimental work of Nelson and Fitzhugh (1948). Although there are extensive studies of the myopathy produced by this drug in animals, there are few reports of human cases with examination of the histochemistry or the ultrastructure of the affected muscles. These investigations were made in one of the cases reported in this paper, which also emphasizes the involvement of the heart in chloroquine myopathy and describes the necropsy findings in a fatal case.
Url:
DOI: 10.1093/oxfordjournals.qjmed.a067261
Affiliations:
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Skeletal muscles were severely affected but there was also clinical evidence in both cases of cardiac involvement and Case 1, in which there was histological evidence of cardiomyopathy, died of heart failure. Muscle biopsy in both cases and skeletal muscle at necropsy in Case 1 showed a striking vacuolar degeneration of about 50 per cent of the muscle-fibres. Histochemical examination showed that the granular (type I) muscle-fibres were preferentially affected. Electron microscopy showed the ultrastructural detail of the extensive degeneration of the muscle-fibres which contain large numbers of myelin figures thought to be a type of lysosome. There were mitochondrial changes which appear to precede the formation of the myelin figures. The literature of other clinical cases and of the experimentally produced myopathy is briefly reviewed. There is evidence that the administration of chloroquine for a long time in high dosage can cause a toxic myopathy. We record here two further cases. The first clinical report of human cases was made by Whisnant, Espinosa, Kierland, and Lambert (1963), but this side effect has been known in animals since the experimental work of Nelson and Fitzhugh (1948). Although there are extensive studies of the myopathy produced by this drug in animals, there are few reports of human cases with examination of the histochemistry or the ultrastructure of the affected muscles. These investigations were made in one of the cases reported in this paper, which also emphasizes the involvement of the heart in chloroquine myopathy and describes the necropsy findings in a fatal case.</div></front></TEI><affiliations><list><country><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Oxfordshire</li></region><settlement><li>Oxford</li></settlement></list><tree><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Hughes, J Trevor" sort="Hughes, J Trevor" uniqKey="Hughes J" first="J. Trevor" last="Hughes">J. 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