Vanishing Muscle; A Disappearing Act and Its Multiple Etiologies (5037)

Objective: To describe the clinical findings, electrodiagnostic study and pathological findings in a case of Late-onset Radiation-Induced Cervicoscapular Muscle Atrophy for Hodgkin’s disease in Puerto Rico. Background: Delayed neurologic adverse events after extended-field radiotherapy (RT) for Hodgkin’s disease is seen more commonly with brachial or lumbar plexopathy and chronic myelopathy. Although a rare entity, delayed weakness of cervical and shoulder girdle musculature in these patients has been described as case reports sharing same clinical presentation and electrophysiologic findings leading to this rare post-RT complication. Design/Methods: Case of a 59y/o male patient with history of HIV on HAART(Dx. 1990), Hypothyroidism, BPH, Neuropathy, Hodgkin Lymphoma (Dx. 1999) s/p chemotherapy and mantle radiation(Tx. 2000), Radiation-Induced lung disease, who presents progressive atrophy of cervical and upper extremities with associated weakness and pain in a 6 year period with accelerated progression during the last year. Reported 34lbs weight loss in a 5month period. Examination was remarkable for pectus excavatum marked atrophy of cervical and deltoid muscles and neck extensor weakness. Laboratories were unremarkable, including undetectable HIV viral load. Cervicothoracic MRI remarkable for spondylolisthesis and diffuse degenerative disease. Left brachial plexus MRI negative for abnormal enhancement, nerve thickening or lesions. Electrodiagnostic study with evidence of sensorimotor peripheral neuropathy and small polyphasic MUAPs with increased insertional and spontaneous activity without an increase in firing rate at left trapezius, supraspinatus and sternocleidomastoid. Patient was referred for muscle biopsy. Results: N/A Conclusions: Late-onset Radiation-Induced Cervicoscapular Muscle Atrophy as a complication of RT for Hodgkin’s disease has been described as a rare post-RT complication. Treatment is focused on rehabilitation and pain management. Our case highlights the importance of clinical awareness and appropriate diagnosis about the late effects of radiation therapy in neuromuscular disease. Disclosure: Dr. Caraballo-Cartagena has nothing to disclose. Dr. Alfonso has nothing to disclose.