A 68-Year-Old Woman With Severe Myalgia

A 68-year-old woman complains of diffuse, severe myalgia. She reports stiffness, heaviness, and cramping, which are most marked in her thighs and calves. The heaviness and discomfort result in a sensation of weakness as well. She rates the pain as 8 on a scale of 1 to 10; it is severe enough to prevent her from doing activities of daily living at least some of the time.

HISTORY

The patient has chronic hypertension, currently managed with an angiotensin-converting enzyme inhibitor and a diuretic taken on alternate days. She has had atrial fibrillation for about 2 years, which is very well controlled with amiodarone(Drug information on amiodarone). About 6 months earlier, her low-density lipoprotein (LDL) cholesterol level was found to be 270 mg/dL; atorvastatin(Drug information on atorvastatin), 40 mg/d, was started. There is a strong family history of vascular disease, including stroke.

PHYSICAL EXAMINATION

This small, slight (50 kg, 1.58 m) woman is in no acute distress. Heart rate is 78 beats per minute and irregular; respiration rate, 14 breaths per minute; and blood pressure, 110/74 mm Hg. She has no tendinous or palpebral xanthomas, and no carotid bruits are audible. Chest is clear; atrial fibrillation is evident. The liver and spleen are not enlarged. Results of a neurological examination are normal; reflexes are symmetrical and strong. No swelling, tenderness, or warmth is noted in any muscle group.

LABORATORY RESULTS

Hemoglobin level and results of a serum chemistry panel are normal. Creatine kinase (CK) level is 19 U/L (normal, 30 to 135 U/L). A fasting lipid panel reveals a total cholesterol level of 168 mg/dL, a high-density lipoprotein cholesterol level of 49 mg/dL, and an LDL cholesterol level of 83 mg/dL. Triglyceride levels are normal.

Answers on Next Page