- •Hereditary myofibrillar myopathy with axonal polyneuropathy, long QT 'interval and familial atrial fibrillation.
- •Phenotype of adult onset and distal leg weakness resembled CMT.
- •Remarkable semitendinosus muscle atrophy was observed.
- •Heterozygous P470S mutation in BAG3 may not be associated with apparent cardiomyopathy.
We report a family with adult-onset myofibrillar myopathy with BAG3 mutation who presented peroneal weakness and axonal polyneuropathy, mimicking axonal Charcot-Marie-Tooth disease. The male proband noticed difficulty in tiptoeing at age 34. At age 42, the examination showed muscle weakness and atrophy in distal lower extremities with diminished patellar and Achilles tendon reflexes. Thermal and vibration sensations were also impaired in both feet. The serum CK level was 659 U/L. On muscle imaging, predominant semitendinosus muscle atrophy coexisted with atrophies in the quadriceps, gastrocnemius and lumbar paraspinal muscles. The muscle biopsy showed myofibrillar myopathy with fiber type grouping. His 68-year-old mother also had suffered from distal leg weakness and sensory impairment since her forties. A heterozygous mutation in BAG3 (P470S) was identified in both patients. Clinical features of myofibrillar myopathy with axonal polyneuropathy were consistent with BAG3-related myopathy. Our patients showed remarkably mild presentations without cardiomyopathy, unlike the majorities of previously reported cases.
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Published online: July 31, 2020
Accepted: July 28, 2020
Received in revised form: June 5, 2020
Received: November 8, 2019
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