Use of dynamic tests of muscle function & histomorphometry of quadriceps muscle biopsies in the investigation of patients with chronic alcohol misuse & Chronic Fatigue Syndrome (CFS)

Ischaemic lactate/ammonia tests, serum carnosinase and

creatine kinase assays and percutaneous needle muscle biopsies

were performed on 10 patients with chronic fatigue syndrome

(CFS), and 10 with chronic alcohol misuse complaining of

muscular symptoms.

Basal serum lactate levels were significantly elevated in

the alcohol misusers compared to the CFS patients, but all

were within the reference range. Lactate profiles after

ischaemic forearm exercise did not differ significantly for

the two patient groups. In one patient previously diagnosed as

having CFS, myoadenylate deaminase deficiency was identified

on the basis of a flat ammonia response to ischaemia and

absent muscle adenosine monophosphate deaminase activity. In

addition, two further patients in the CFS group were

subsequently shown to have other disorders: one had

polymyositis and one had myopathy with mild type II fibre

atrophy of unknown cause. Histomorphometric examination of

muscle needle biopsy in the alcohol misusers showed features

of chronic alcohol-induced skeletal myopathy in six patients

and polymyositis in one patient. Type II fibre atrophy factors

were significantly elevated in the alcohol group but were

within the reference range in CFS patients. Dynamic tests of

muscle function and muscle histology are valuable tools in

excluding alternative pathology in CFS, whereas muscle

histomorphometry is of the greatest value in the diagnosis of

chronic alcoholic myopathy.

Wassif WS, Sherman D, Salisbury JR, Peters TJ

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