A patient infected with HIV may develop an acquired nemaline myopathy. Occasionally this may be the first indication of the underlying infection.
Clinical features:
(1) muscle weakness and wasting, especially in proximal and limb-girdle muscles
(2) weakness in neck extensors
(3) occasionally respiratory insufficiency
(4) occasionally dysphagia
Laboratory findings:
(1) The serum creatine kinase is normal or mildly increased.
Microscopic findings on muscle biopsy:
(1) Small rod-shaped bodies are seen within the cytoplasm of many myocytes. Special stains (modified Gomori trichrome stain on frozen section; phosphotungstic acid hematoxylin stain) may be needed to visualize them.
(2) Myocytes may show fiber necrosis, vacuoles or other degenerative changes.
(3) Electron microscopy shows the small nemaline rods (possibly made of Z disk material).
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