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Case Reports
. 2020 May 6;7(4):e735.
doi: 10.1212/NXI.0000000000000735. Print 2020 Jul.

Anaplastic lymphoma kinase inhibitor-associated myositis

Akinori Uruha  1 , Stefan Kliesch  1 , Simone Schmid  1 , Carsten Dittmayer  1 , Hans-Hilmar Goebel  1 , Alexander Dressel  1 , Werner Stenzel  2 , Robert Handreka  1
Affiliations
Case Reports

Anaplastic lymphoma kinase inhibitor-associated myositis

Akinori Uruha et al. Neurol Neuroimmunol Neuroinflamm. .
No abstract available

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Figures

Figure
Figure. MRI and pathology of skeletal muscles
(A–E) 3 T MRI of the cervical spine. Upper row shows the initial status at presentation (A–C): marked bilateral muscular edema was observed in trapezius, splenius (arrow), and semispinalis (arrowhead) muscles in sagittal and axial fat-suppressed T2-weighted imaging (A and B: FS-T2WI). IV contrast administration shows vivid enhancement in the same region in sagittal subtracted T1-weighted imaging (C: Gd-T1WI). These findings are suggestive of inflammation of the muscles. Lower row shows improvement of the inflammatory change 7 weeks after initiation of corticosteroid treatment in sagittal and axial FS-T2WI (D and E). (F–M) Pathology of the biopsied semispinalis capitis muscle. Most fibers are atrophic, and marked endomysial fibrosis is present (F: modified Gömöri trichrome stain [mGT]. The arrow and the asterisk indicate a myofiber and fibrous tissue, respectively. Bar: 50 μm). Overexpression of major histocompatibility complex class I is observed on sarcolemma of many fibers (arrow), whereas major histocompatibility complex class II is not overexpressed on myofibers (G and H: immunohistochemistry for major histocompatibility complex classes I and II [MHC I and II]). Myofibers showing C5b-9 complement deposition predominantly on sarcolemma of non-necrotic fibers (arrow) are scattered in <3% of the total number of myofibers (I: immunohistochemistry for C5b-9 complements [membrane attack complex]). There are several clusters of mononuclear cells, which consist of predominantly CD20-positive cells (J: hematoxylin and eosin stain [H&E]. K: immunohistochemistry for CD20). Focal infiltration of CD8− (L) or CD68− (M) positive cells are observed both in perimysium and endomysium, immunohistochemically. These staining results argue in favor of a B-cell mediated process, likely to interfere with the interferon-mediated pathways, accompanied by a solid T-cell response within the tissue as well.
See this image and copyright information in PMC

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