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Polymyositis — SCE Neurology MCQ

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HardNeuromuscularPolymyositisSCE Neurology

An older adult has slowly progressive quadriceps and finger-flexor weakness, preserved sensation and only partial steroid response. Muscle biopsy shows endomysial inflammation with rimmed vacuoles. What is the diagnosis?

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Correct answer: B — Sporadic inclusion body myositis affecting finger flexors and quadriceps

The best answer is “Sporadic inclusion body myositis affecting finger flexors and quadriceps”. Finger-flexor and quadriceps involvement, older age, slow progression, rimmed vacuoles and poor steroid response identify inclusion body myositis rather than polymyositis. The alternatives “Immune-mediated necrotising myopathy with sparse inflammation, after excluding important mimics”, “Dermatomyositis with perifascicular atrophy and characteristic rash”, “Polymyalgia rheumatica without structural muscle injury, when the phenotype supports it”, “Steroid-induced myopathy with normal enzymes and non-inflammatory biopsy” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: National Clinical Guideline for Stroke: acute care: https://www.strokeguideline.org/chapter/acute-care/