Premium
Necrotizing myopathy in critically‐ill patients
Author(s) -
Helliwell Timothy R.,
Coakley John H.,
Wagenmakers Anton J. M.,
Griffiths Richard D.,
Campbell Iain T.,
Green Ceri J.,
McClelland Peter,
Bone John M.
Publication year - 1991
Publication title -
the journal of pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.964
H-Index - 184
eISSN - 1096-9896
pISSN - 0022-3417
DOI - 10.1002/path.1711640406
Subject(s) - medicine , necrosis , muscle biopsy , atrophy , wasting , pathology , myopathy , rhabdomyolysis , sepsis , critically ill , weakness , biopsy , surgery
Skeletal muscle wasting is commonly observed in critically‐ill patients and has been attributed to catabolic fibre atrophy and to neuropathy. This study describes the occurrence of a necrotizing myopathy in 15 out of 31 critically‐ill patients who had percutaneous biopsies taken from the tibialis anterior muscles. While most cases showed necrosis of isolated fibres, 5 of the 12 patients who had serial biopsies showed progressive necrosis of up to 95 per cent of the fibres. One other case showed infarction and one case had staphylococcal vasculitis. Atrophy of type 1 and/or type 2 fibres was documented by morphometry in 12 cases. Myoglobin‐containing casts were demonstrated immunohistochemically in renal tubules on either biopsy or necropsy material in 5 out of 7 cases. The presence of muscle necrosis was a clinically unexpected finding which may contribute to weakness, complicate the interpretation of tissue biochemistry and energy balance studies, and potentiate renal failure. The necrosis is probably multifactorial in origin, with ischaemia and sepsis contributing factors.