We recently reported two unrelated patients with an unusually severe form of rippling muscle disease (RMD), 1 a rare myopathy characterized by signs of an increased muscle irritability. 2 In nearly all known cases, RMD is inherited as an autosomal dominant trait caused by heterozygous missense mutations in the caveolin-3 gene (CAV3).3 Both patients showed apparently homozygous CAV3 missense mutations (L86P and A92T), which might argue for the existence of an autosomal recessive form of RMD caused by CAV3 mutations. Unfortunately, in both cases we could not perform clinical or genetic studies in additional family members. We therefore could not exclude that heterozygous carriers of these mutations show signs of RMD, such as the typical rippling phenomenon, muscle mounding, percussion/pressureinduced rapid muscle contractions (PIRCs), or an increase in serum creatine kinase (CK). 4 In the case of such symptoms, the mutations had to be regarded as "normal" autosomal dominant RMD mutations causing a more severe phenotype in homozygotes, whereas an autosomal recessive form of RMD with CAV3 mutations would require the absence of symptoms in carriers.We were now able to extend our knowledge about one of these mutations (ie, A92T) and to substantiate the existence of autosomal recessive RMD with CAV3 mutations. We identified a novel family of German ancestry, with two children affected by RMD. The 7-year-old son (II-2, Fig) complained of nocturnal myalgia of the legs. Psychomotor development was normal. Muscle strength was discretely reduced in the arms; strength in other muscles was normal. PIRCs could be provoked on skeletal muscles of the upper and lower extremities. Increased CK values were repeatedly found (up to 1,050U/L; normal, Ͻ217U/L). Electrocardiogram was normal and echocardiography showed a minimal insufficiency of the mitral and tricuspidal valves without clinical significance. A diagnostic muscle biopsy did not show any signs of muscular dystrophy or myopathy. Immunohistochemistry showed absence of plasmalemmal Cav3 staining (data not shown). The patient's 13-year-old sister (II-1, see Fig) also reported nocturnal myalgia of the legs. Similar to her brother, PIRCs could be provoked on skeletal muscles of the upper and lower extremities. Otherwise, physical examination was normal. The CK value was elevated up to 528U/L (normal, Ͻ217U/L). Electrocardiogram and echocardiography were normal. In both children, there was no growth retardation or arrhythmogenic cardiomyopathy as has been reported in one small family with a syndromic form of RMD with autosomal recessive inheritance and unknown CAV3 mutational status.5 Both parents are healthy. Physical examination showed no signs of muscle rippling, mounding, or PIRCs. CK values were repeatedly normal in the 40-year-old father (up to 74U/L; normal, Ͻ140U/L). In the 38-year-old mother, there was a borderline high CK value (157U/L; normal, Ͻ140U/L) once. A control measurement (110U/L) was normal. Two older siblings of the patients are healthy and show normal