SHM Converge Scientific Abstract ePoster Gallery-Troubling Labs

Pdf Summary

This case describes an 80-year-old woman with hyperlipidemia who presented with jaundice and abnormal liver tests. Workup revealed obstructive jaundice from a 2.6 cm pancreatic head mass. She was also found to have severe rhabdomyolysis with markedly elevated creatinine kinase, acute kidney injury, and urine findings consistent with myoglobinuria.<br /><br />Although her liver enzymes improved after biliary stenting, her CK continued to rise despite IV fluids. Further history uncovered progressive proximal thigh weakness over a month and dysphagia to pills, suggesting an inflammatory myopathy. Her differential included malignancy-associated myopathy, statin-induced myopathy, autoimmune myositis, hypothyroidism, alcohol-related disease, HIV, glucocorticoids, and antiretroviral-associated myopathy. Because she had a pancreatic adenocarcinoma, a paraneoplastic myopathy was strongly considered.<br /><br />Serologic testing was negative for anti-Jo-1, anti-synthetase antibodies, anti-HMG-CoA reductase, and anti-SRP. MRI of the thighs showed bilateral muscle signal changes compatible with myositis and diffuse edema, supporting the diagnosis. A muscle biopsy was attempted but was non-diagnostic due to inadequate muscle sampling. Despite inconclusive biopsy results, the overall clinical picture, cancer association, negative serologies, and MRI findings supported treatment for inflammatory myopathy.<br /><br />She was started on high-dose steroids and improved quickly, with downtrending CK and recovery of renal function to baseline before discharge.<br /><br />Key teaching points: paraneoplastic myopathies should be considered in cancer patients with new muscle weakness or dysphagia; statin-related disease must also be considered given its frequency; and diagnosis may rely on imaging, clinical context, and exclusion of other causes when biopsy is non-diagnostic.

Asset Subtitle

Humayra Mayat

Meta Tag

Author List Humayra Mayat, Shwetha Iyer

Category Clinical Vignettes

Concept Inflammatory Myopathy

Concept Paraneoplastic Myopathy

Concept Statin-Induced Myopathy

Concept Malignancy

Concept Statin

Distinguished Non-Finalist

Presenter Organization Montefiore Medical Center

Presenting Author Humayra Mayat

Track Adult

Keywords

pancreatic adenocarcinoma

paraneoplastic myopathy

rhabdomyolysis

obstructive jaundice

creatine kinase

acute kidney injury

myoglobinuria

inflammatory myositis

muscle weakness

dysphagia

Inflammatory Myopathy

Paraneoplastic Myopathy

Statin-Induced Myopathy

Malignancy

Statin