These biopsies are from a 60 year old gentleman who was admitted to the ICU for a severe COPD exacerbation. He has a known history of COPD, diabetes, and hyperthyroidism, was not taking his medications, and came into the emergency department with hypercarbic respiratory failure one week ago. He was intubated for airway protection due to altered mental status. He has been on high dose IV glucocorticoids for the COPD exacerbation.He had a prolonged extubation due to difficulty weaning him from the ventilator. Even after he was successfully extubated, he complained of weakness and exam showed a flaccid weakness greater in the proximal than distal extremities affecting all limbs. His facial muscles are also weak, though extraocular movements are intact. Sensation is normal. Deep tendon reflexes are normal. CK is elevated.
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Insult to Injury
This is critical illness myopathy, seen in patients in the ICU especially if they have been on the ventilator, received IV glucocorticoids, or received paralytics. The image shows abnormal variation in fiber size on a muscle biopsy.
Sources: UpToDate; pn.bmj.com.
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