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Musculoskeletal and Sports Medicine

Inclusion Body Myositis Diagnosis Complicated by Comorbid Pain and History of Chemotherapy: A Case Study

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 3
Has Audio

    Primary Author(s)

  • Kelly Michanczyk, MD

    Resident Physician
    Vanderbilt University Medical Center
    Nashville, Tennessee

    • Co-Author(s)

  • GA

    Gary Allen, MD

    Resident Physician
    Vanderbilt University Medical Center, Tennessee

  • Aaron J. Yang, MD

    Associate Professor
    Vanderbilt University Medical Center
    Nashville, Tennessee

Disclosure(s):
Kelly Michanczyk, MD: No financial relationships to disclose
Case Diagnosis: A 79 year-old male with a history of chronic neck and back pain, acute myeloid leukemia, and lung cancer (treated with chemotherapy), presented with progressive bilateral leg weakness, muscle cramping, and right foot drop, ultimately diagnosed with inclusion body myositis (IBM).

Case Description or Program Description: The patient’s symptoms persisted despite physical therapy. His primary physician ordered lumbar MRI and referred him to spine clinic. The patient also developed forward head drooping, bilateral proximal arm weakness, and gait disturbance. Physical exam revealed kyphotic cervical posture, bilateral hand muscle atrophy, 0/5 strength on right dorsiflexion, 0/5 strength on right great toe extension, and right foot slapping on ambulation.

Setting: Outpatient spine clinic

Assessment/Results: MRIs of the cervical, thoracic, and lumbar spine revealed slight right paracentral disc bulge at L4-5 affecting the traversing L5 nerve root, but no significant canal or neural foraminal stenosis to explain his symptoms. CK was elevated to 817. Myositis panel, anti-cN-1A, CRP, ESR, ANCA, HMGCR were negative or normal. EMG showed concern for chemotherapy-induced neuropathy, stating there was no evidence of generalized myopathy or myositis. Deltoid muscle biopsy revealed an inflammatory myopathy with rimmed vacuoles, most suspicious for IBM.

Discussion (relevance): The differential diagnosis was broad and included inflammatory myopathy such as polymyalgia rheumatica, motor neuron disease, chemotherapy-induced polyneuropathy, and autoimmune conditions. This patient’s chronic back and neck pain, mild disc bulge on MRI, and history of chemotherapy made the diagnosis of IBM more challenging.

Conclusions: Because IBM is a rare condition, it is important to identify its distinguishing features in the setting of comorbid conditions. Here, IBM presented in a patient with painful muscle cramping. This patient’s distal asymmetric muscle involvement, lack of spinal structural explanation of foot drop, and isolated elevated CK on labs were early clues leading to muscle biopsy.