Muscle weakness and Myoglobinuria

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Iqra Qamar M.D.[2]

## Differential Diagnosis of Muscle weakness and Myoglobinuria

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Organ system  | Disease  | Symptoms  | History  | Physical

Examination

| Diagnosis

|
|
|
|
|

Age of onset  | Muscle weakness  | Fever  | Myalgia  | Contractures | Gait abnormality  | Neuropathy  | Atrophy  | Stiffness  | Myoglobinuria  | Other features  | Laboratory Findings  | Creatine Kinase  | Muscle Biopsy  | Electromyogram
Medication−induced  | Statins[1] | 60+  | Proximal  | −  | \+  | −  | −  | −  | −  | −  | −/+(Rhabdomyolysis)  |

* N/A

* Positive h/o medications
* H/o other medication use

* Tenderness
* Muscle aches

* ↑↑ Liver enzymes

* ↑↑

* Necrosis
* Degeneration, and regeneration of fibers
* Phagocytic infiltration

* Normal

Endocrine  | Hyperaldosteronism with myopathy[2] | 50  | Proximal

distal  | −  | −  | −  | −  | −  | −  | −  | \+

Rhabdomyolysis

* Palpitations
* Hypertension

* Episodes of increased heart beats

* Hyperpigmentation

* Hypokalemia

* Normal

* Normal

* Normal

Hyperthyroidism[3] | 40  | Proximal  | −  | −  | −  | −  | −  | \+  | \+  | \+  |

* Signs of hyperthyroidism

* H/o of weight loss

* Sweating
* Tremor
* Neck swelling

* Decreased TSH

* ↑↑

* Non specific

* Myotonic

Hypothyroidism[4] | 55  | Proximal  | −  | \+  | \+  | −  | −  | \+  | \+  | \+ Rhabdomyolysis |

* Signs of hypothyroidism

* H/o weight gain

* Myxoedema
* Muscle pseudohypertrophy

* Increased TSH

* ↑↑

* Nonspecific

* Normal

Infectious  | Influenza[5] | Variable  | Proximal and Distal  | \+  | \+  | −  | \+  | −  | −  | −  | \+  |

* Fever
* Malaise
* Rhinorrhea
* Muscle pain worse with movement

* Cold weather
* H/o Ill contacts

* Muscle weakness, tenderness, and swelling.

* ↑↑ Liver enzymes
* Positive PCR

* ↑↑

* N/A

* N/A

## References

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1. ↑ Tomaszewski M, Stępień KM, Tomaszewska J, Czuczwar SJ (2011). "Statin-induced myopathies". Pharmacol Rep. 63 (4): 859–66. PMID 22001973.
2. ↑ Sambrook MA, Heron JR, Aber GM (April 1972). "Myopathy in association with primary hyperaldosteronism". J. Neurol. Neurosurg. Psychiatry. 35 (2): 202–7. PMC 494037. PMID 5037033.
3. ↑ Li Q, Liu Y, Zhang Q, Tian H, Li J, Li S (July 2017). "Myopathy in hyperthyroidism as a consequence of rapid reduction of thyroid hormone: A case report". Medicine (Baltimore). 96 (30): e7591. doi:10.1097/MD.0000000000007591. PMC 5627834. PMID 28746208.
4. ↑ Khaleeli AA, Griffith DG, Edwards RH (September 1983). "The clinical presentation of hypothyroid myopathy and its relationship to abnormalities in structure and function of skeletal muscle". Clin. Endocrinol. (Oxf). 19 (3): 365–76. PMID 6627693.
5. ↑ Bove KE, Hilton PK, Partin J, Farrell MK (1983). "Morphology of acute myopathy associated with influenza B infection". Pediatr Pathol. 1 (1): 51–66. PMID 6687269.