Answer to question (EMQ) of the day – a history of weakness and fatigue


Thanks for all of your great responses to our question of the day – some good analyses and discussion.

So here we go with the likely pathology …

  • Symmetrical findings make a central lesion less likely (they would localise).
  • The reflexes and sensation are intact, making a cord or peripheral nerve lesion unlikely.
  • The absence of fatigability makes a neuromuscular junction lesion less likely (myasthenia etc).
  • This sounds like a myopathy: the rash therefore suggests polymyositis (the rash is a heliotropic rash named after the purple heliotrope flower). The CK is likely to be very high (in the thousands, NR <150 iu/l).
  • The dysuria and cough are intended as distracters.

Look out for our next question of the day coming soon, and remember there are thousands more in the login area!

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