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Muscle Biopsy: Type II Muscle Fibre Atrophy and Focal Myositis

Rossy191276

Senior Member
Messages
145
Location
Brisbane, Australia
I am wondering if anyone else has had muscle biopsies where the findings have been severe Type II muscle atrophy or focal myositis?

The report said my results were not indicative of primary mitochondrial disease (I have attached report)

My doctors did rule out the known common causes of Type II fibre atrophy except disuse since I was bed bound for some time before test but they felt that it was unlikely such severe atrophy would have occurred from disuse. And they are at a loss as to where to go next...

I also found a previous research article on Post Viral Fatigue in 1991 where they found 39 of 50 people in study had Type II atrophy.

Any experience with this would be appreciated.

@BeautifulDay
 

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BeautifulDay

Senior Member
Messages
372
Good morning @Rossy191276
I have no experience or knowledge with Type II muscle atrophy or focal myositis, but here is what I could find in a few minutes before heading out in the snow.

At first glance it looks like doctors will initially look to the easier identifiable causes such as steroid, or statin, or red yeast rice as a cause. Once those have been ruled out, they need dig further. Let me see if I can do a slightly deeper dive when I get back in. Snow day here (it just started) and all three kids home. I need to grab some treats for our two days inside that are to come as the snow piles up.

http://onlinelibrary.wiley.com/doi/10.1111/j.1755-5922.2011.00267.x/full
 

Rossy191276

Senior Member
Messages
145
Location
Brisbane, Australia
Good morning @Rossy191276
I have no experience or knowledge with Type II muscle atrophy or focal myositis, but here is what I could find in a few minutes before heading out in the snow.

At first glance it looks like doctors will initially look to the easier identifiable causes such as steroid, or statin, or red yeast rice as a cause. Once those have been ruled out, they need dig further. Let me see if I can do a slightly deeper dive when I get back in. Snow day here (it just started) and all three kids home. I need to grab some treats for our two days inside that are to come as the snow piles up.

http://onlinelibrary.wiley.com/doi/10.1111/j.1755-5922.2011.00267.x/full

Please enjoy yourself and take your time to let me know anything you come up with :)... As I said the only thing i could find was the study I mentioned...
 

pattismith

Senior Member
Messages
3,926
type 2 fibre atrophy doesn't seem to be a specific finding, but focal myositis may indicate an inflammatory process?

I read that in some myositis, we can find type 2 fibre atrophy as well ... Maybe looking for focal myositis causes would help
 

pattismith

Senior Member
Messages
3,926
@Rossy191276

here a definition I found for focal myositis, but I'm not sure that it matches well with your symptoms:

"Focal myositis are inflammatory muscle diseases of unknown origin. At the opposite from the other idiopathic inflammatory myopathies, they are restricted to a single muscle or to a muscle group. They are not associated with extramuscular manifestations, and they have a good prognosis without any treatment. They are characterized by a localized swelling affecting mostly lower limbs. The pseudo-tumor can be painful, but is not associated with a muscle weakness. Creatine kinase level is normal. Muscle MRI shows an inflammation restricted to a muscle or a muscle group. Muscle biopsy and pathological analysis remain necessary for the diagnosis, showing inflammatory infiltrates composed by macrophages and lymphocytes without any specific distribution within the muscle. Focal overexpression of HLA-1 by the muscle fibers is frequently observed. The muscle biopsy permits to rule out differential diagnosis such a malignancy (sarcoma). Spontaneous remission occurs within weeks or months after the first symptoms, relapse is unusual."
 

Rossy191276

Senior Member
Messages
145
Location
Brisbane, Australia
@Rossy191276

here a definition I found for focal myositis, but I'm not sure that it matches well with your symptoms:

"Focal myositis are inflammatory muscle diseases of unknown origin. At the opposite from the other idiopathic inflammatory myopathies, they are restricted to a single muscle or to a muscle group. They are not associated with extramuscular manifestations, and they have a good prognosis without any treatment. They are characterized by a localized swelling affecting mostly lower limbs. The pseudo-tumor can be painful, but is not associated with a muscle weakness. Creatine kinase level is normal. Muscle MRI shows an inflammation restricted to a muscle or a muscle group. Muscle biopsy and pathological analysis remain necessary for the diagnosis, showing inflammatory infiltrates composed by macrophages and lymphocytes without any specific distribution within the muscle. Focal overexpression of HLA-1 by the muscle fibers is frequently observed. The muscle biopsy permits to rule out differential diagnosis such a malignancy (sarcoma). Spontaneous remission occurs within weeks or months after the first symptoms, relapse is unusual."
Cheers @pattismith yes I think I read that.. it seems both findings lead to unknown causes from doctors point of view. I wish so much that more muscle biopsy research had done on patients with muscle weakness over the years. As I said I read an article from 1991 that found 39 of 50 cfs patients had type II fibre atrophy and the final statetment said something like "we need this to be followed up". 25 years later....
 

pattismith

Senior Member
Messages
3,926
@Rossy191276 ,

do you have or had swelling in your one or several of your muscles?
Did histopathology show any inflammatory infiltrates with macrophages and lymphocytes?

Focal myositis clinically looks like a pseudotumor in a muscle. It is most often an autoimmune process, and some cases need immunomodulator treatment.( although some rare cases can have infectious origin).

One the other hand, if many of your muscles are affected by inflammation, without any particular swelling) it looks more like a polymyositis.
 

Rossy191276

Senior Member
Messages
145
Location
Brisbane, Australia
@Rossy191276 ,

do you have or had swelling in your one or several of your muscles?
Did histopathology show any inflammatory infiltrates with macrophages and lymphocytes?

Focal myositis clinically looks like a pseudotumor in a muscle. It is most often an autoimmune process, and some cases need immunomodulator treatment.( although some rare cases can have infectious origin).

One the other hand, if many of your muscles are affected by inflammation, without any particular swelling) it looks more like a polymyositis.

No @pattismith I didn't have swelling, the biopsy was done on my thigh due to severe muscle weakness I have in thighs, chest, and less so arms. It said there was a mixture of b cells, t cells, and macrophages that appear relatively restricted to the single inflamed fascicle.

Yes I wonder what they would find if they did different muscles. My worst symptom is severe weakness in chest (I couldn't even register a result on the spirometer, I haven't been able to talk for most of the last 9 months.) I don't have any swelling so doesn't seem to quite fit the focal myositis finding.

Thanks for taking the time to reflect on these results.

Rossy
 

Gingergrrl

Senior Member
Messages
16,171
My worst symptom is severe weakness in chest (I couldn't even register a result on the spirometer, I haven't been able to talk for most of the last 9 months.)

Hi Rossy, can you remind me how they interpreted your spirometry test and if it showed pulmonary restriction, obstruction, both or neither? I was also wondering if you have ever had a "Sniff test" of the diaphragm?

At my sickest, I also was not able to register anything on the spirometer although there was never any point that I was unable to speak.