Fibromyalgia (FM) in hyperkalemic periodic paralysis

A 43-year-old woman presented at the age of 38 with joint
pains and muscle stiffness. Tender points were found
fulfilling ACR criteria (1) for fibromyalgia. She had well
developed muscles and decreasing muscle power since the age of
35. Muscle pains increased after exercise. Her 10-year-old son
had similar symptoms and one paralytic attack. Muscle pain and
fatigue increasing with age were found by history in three
close relatives. Forearm cold water test produced myotonia in
both mother and son. Electromyography was normal and muscle
biopsy showed minor unspecific changes. Biochemical
investigation of muscle mitochondrial function was normal.

Peroral potassium load test produced complete muscle paralysis
at a potassium serum level of 5.0 mmol/l. Autosomal dominant
hyperkalemic periodic paralysis was diagnosed. Frequent
carbohydrate enriched meals, peroral bendroflumethiazide and
restriction to submaximal exercise improved muscle and joint
pain. Salbutamol peroral spray relieved the periodic weakness.

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