Anti-Ku Antibody-Positive Myositis Presenting as a Wide Range of Axial Myopathies and Myocarditis: A Case Report and Review of the Literature

Idiopathic inflammatory myopathies (IIMs) are autoimmune diseases predominantly affecting proximal muscles; paraspinal muscle involvement is relatively rare. Because paraspinal myopathies do not always cause clinically-evident symptoms, the diagnosis of IIMs with axial myopathies can be challenging. Anti-Ku autoantibodies, initially reported in polymyositis/systemic sclerosis overlap syndrome, are myositis-associated antibodies (MAAs) observed in patients with a wide variety of connective tissue diseases (CTDs). Few reports have been published demonstrating predominant axial myopathy in IIM patients with anti-Ku antibodies. Herein, we investigated a previously healthy Japanese woman in her early 70s who presented with Raynaud’s phenomenon, back pain, and exertional dyspnea. The creatine kinase (CK) was elevated and antinuclear antibody staining was positive, but myositis-specific antibodies (MSAs) were negative. Magnetic resonance imaging (MRI) revealed myocarditis and a wide range of axial muscle inflammation, including bilateral thoracolumbar paraspinal, infraspinatus, and trapezius muscles. The muscle biopsy was consistent with IIM. In addition, anti-Ku antibody was positive. Administration of prednisolone and tacrolimus quickly alleviated the symptoms and the CK level returned to normal. The diagnosis of IIM was arduous in this case because she did not present with camptocormia, muscle weakness involving the proximal limbs was not apparent, and MSAs were negative. Whether axial myopathy and myocarditis are more prevalent in IIM patients with than without anti-Ku antibodies is uncertain. Clinicians should suspect axial myopathy and MAAs, such as anti-Ku antibodies, especially in patients in whom muscle weakness of the proximal limbs is not noticeable.

Complete bilateral ophthalmoplegia in malignant intracranial hypertension in a child

Purpose: To describe a case of fulminant idiopathic intracranial hypertension (IIH) in a child with “malignant” presentation. Case report: A 16-year-old, previously healthy, girl presented with bilateral visual loss and bilateral global limitation of eye movements in the absence of headache. Extensive laboratory evaluation for infectious, inflammatory, autoimmune, and neoplastic conditions was negative. Magnetic resonance imaging (MRI) of the brain and lumbar puncture findings were consistent with a diagnosis of IIH. Extraocular motility improved in the next few days as well as optic disc edema but visual acuity remained poor. Conclusion: The authors believe that the acute, severe, and fulminant (“malignant”) presentation with markedly elevated intracranial pressure may produce the unique presentation of severe vision loss and bilateral complete ophthalmoplegia. Interestingly, there was no headache. To our knowledge this is the first such case to be reported in the English language ophthalmic literature.

Osteochondromyxoma of Talus

Osteochondromyxoma is a rare bone tumour. Bone tumours of the talus are also uncommon, and accounts to be between 8% to 23% in tumours of the foot. A 28-year-old man presented with chronic right ankle pain. He had underlying left knee ligament and meniscal injury. Special examination tests for ligament injury were negative. Magnetic Resonance Imaging (MRI) revealed a benign bone lesion of talus with reactive oedema of sinus tarsi. Excision of lesion was done and subsequent histopathological examination confirmed the diagnosis of ostechondromyxoma.