Case Report

Mycophenolate Mofetil Induced Myopathy in a Patient with Lupus Nephritis

MARÍA GALINDO, ANA CABELLO, BEATRIZ JOVEN, ANA ALONSO, PATRICIA CARREIRA, JESÚS PORTA, JOSÉ RAMÓN RICOY, ISABEL MATEO, and JOSÉ L. PABLOS

ABSTRACT.

We describe a case of mycophenolate mofetil (MMF) induced myopathy in a patient with lupus nephritis. Two months after starting MMF treatment she developed asthenia, lower limb weakness, and abnormal increase of muscle enzymes. An electromyogram showed a myogenic pattern with small polyphasic discharges without neurogenic signs involving proximal muscles of lower limbs. Muscle biopsy revealed the presence of fibers of variable size with irregular sarcoplasmic basophilic areas. Using oxidative enzyme techniques, many type I fibers showed a moth-eaten appearance resembling minicores. The ultrastructural findings consisted of myofibrillary lesions with multiple small foci of Z-band streaming. MMF withdrawal was followed by complete clinical and enzymatic recovery. (J Rheumatol 2005;32:188-90)

Key Indexing Terms:

MYCOPHENOLATE MOFETIL
TOXICITY
MYOPATHY
SYSTEMIC LUPUS ERYTHEMATOSUS

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From the Rheumatology, Pathology, and Neurology Units, Hospital 12 de Octubre, Madrid, Spain.

M. Galindo, MD, Rheumatology Unit; A. Cabello, MD, Pathology Unit; B. Joven, MD, Rheumatology Unit; A. Alonso, MD, Neurology Unit; P. Carreira, MD, Rheumatology Unit; J. Porta, MD, Neurology Unit; J.R. Ricoy, MD, Pathology Unit; I. Mateo, MD; J.L. Pablos, MD, Rheumatology Unit.

Address reprint requests to Dr. M. Galindo, Servicio de Reumatología, Hospital 12 de Octubre, Carretera de Andalucía Km 5.4, 28041 Madrid, Spain. E-mail: reuma@h12o.es

Submitted April 7, 2004; revision accepted July 30, 2004.

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