Published in:
01-09-2019 | Letter to the Editor
Late onset necrotizing autoimmune myopathy 1 year after cessation of statin treatment
Published in: Acta Neurologica Belgica | Issue 3/2019
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Fig. 1
Necrotizing myopathy of the rectus femoris muscle. a Increased muscle fiber caliber spectrum with hypertrophic (black asterisk), partly atrophic (arrows) as well as atrophic muscle fibers (arrow head), and a single necrotic muscle fiber with early signs of myophagia (white asterisk) as indicated by two macrophages in the sarcoplasm of the necrotic muscle fiber. H&E staining; original magnification × 400. b Enzyme histochemistry with acid phosphatase depicts the necrotic muscle fiber with a myophagic reaction but no further endomysial inflammatory infiltrates; original magnification × 400. c In the endomysial tissue, there are only single T-cells which do not invade unaffected muscle fibers. Immunohistochemistry with monoclonal rabbit anti-human CD3 (DCS, Hamburg, Germany) and slight counterstaining with hemalum; original magnification × 200. d Endomysial inflammatory infiltrates are dominated by macrophages and numerous macrophages phagocytize necrotic muscle fibers. Immunohistochemistry with monoclonal mouse anti-human CD68 (DCS) and slight counterstaining with hemalum; original magnification × 200. e Note the focally weak and heterogeneous sarcolemmal upregulation of MHC class I antigen (arrows). Immunohistochemistry with monoclonal mouse anti-human MHC class I antigen (Dako, Hamburg, Germany) and slight counterstaining with hemalum; original magnification × 200. f A necrotic muscle fiber expresses the membrane attack complex C5b-9 in the sarcoplasm (arrow). Immunohistochemistry with monoclonal mouse anti-human C5b-9 (Dako) and slight counterstaining with hemalum; original magnification × 200