No abstract

T h e interesting report by Scoppetta et aL2 on distal rnuscular dystrophy prompts us to share our similar experience of a patient with distal weakness, a muscle biopsy showing dystrophic changes, and massive elevation of serum creatine kinase.This 28-year-old male noted leg weakness at age 19 years. Prior to that he had been active in sports, particularly basketball and weight lifting. T h e weakness was most noticeable in the calves, as he was unable to stand o n his toes and his gait was flat-footed. T h e course has been very slowly progressive, and in the past 5 years, mild weakness of distal upper extremity muscles has emerged. Two distant male relatives died of Duchenne dystrophy, an interesting coincidence but irrelevant to our patient's disorder.Examination revealed a healthy appearance, but there was moderate wasting of calf and forearm muscles. His gait lacked effective push-off, arid toe-walking was impossible, although heel-walking was normal. Manual testing showed marked weakness in triceps surae muscles and mild involvement of anterior tibialis muscle and wrist flexors and extensors. T h e ankle tendon jerks were absent, but the remainder were normal. N o muscle hypertrophy, sensory deficit, rnyotonia, o r cranial nerve abnormalities were apparent.Several serum creatine kinase assays have ranged between 12,012 and 17,423 IUlliter (normal