Alcoholic Myopathies, Acute and Chronic

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Background    Histopathology & Immunohistochemistry

BACKGROUND AND CLINICAL INFORMATION: Head  

Summary: Acute alcoholic myopathy (acute alcoholic rhabdomyolysis) is an acute rhabdomyolytic condition that occurs in chronic alcoholics, often associated with weeks of heavy drinking. Recovery is often rapid. Chronic alcoholic myopathy is a clinically characterized by progressive muscle weakness particuolarly in the shoulder girdle and histologically by type 2 fiber atrophy.

Clinical:

·        Acute alcoholic myopathy: This often occurs in alcoholics that have been drinking heavliy for weeks and is preceded by vomiting and diarehea for one to two days before its development. Clinically, there is pain, tenderness, and weakness of proximal muscles especially those of the shoulder girdle. Neck and face may be involved. Myoglobinuria occurs and CK often rises to the range of thousands. Recovery is relatively rapid.

·        Chronic alcoholic myopathy: This is a chronic condition that evolves over weeks or months and characterized by weakness of the proximal muscle. CK is elevated in about 10-30% of these patients. They are often associated with cardiomyopathy. Complete or partial recovery after abstinence is possible. It is believed that chronic alcoholic myopathy correlates with the total lifetime dose of alcohol ingestion.

HISTOPATHOLOGY AND IMMUNOHISTOCHEMISTRY: Head

Acute alcoholic myopathy: In the acute phase, there are scattered necrotic fibers that coexist with regenerating fibers. Type 1 fibers are preferentially affected.

Chronic alcoholic myopathy: Type 2 fiber atrophy with “moth-eaten” fibers on oxidative enzyme reactions. Hypercontraction may be prominent.