PMC5274690_01
Pathologic findings in quadriceps muscle biopsy. (a) NADH stain. Chronic myopathic changes with fiber size variation and myofibrillar alterations, including many lobulated fibers (arrows). (b) Gomori trichrome stain. Many dark staining nemaline rods are seen in a highly atrophic fiber (black arrow) and aggregated beneath the sarcolemma (white arrows) and scattered in sarcoplasm in these adjacent myofibers.
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fig1
Ab IgG) revealed no abnormalities. In view of a lack of obvious cause for the patient's muscle weakness, a muscle biopsy of the left quadriceps was performed. The biopsy showed chronic myopathic changes with many lobulated fibers and several fibers containing rods, suggesting an adult-onset nemaline myopathy (Figures 1(a) and 1(b)). A single fiber with rods was also detected in the deltoid muscle.
Coronal T2 weighted image through the orbit demonstrates inferior displacement of the lateral rectus muscles bilaterally (arrows) without abnormal signal.
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Imaging demonstrated inferior displacement of the lateral rectus muscle bilaterally (Figure 2).