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Diagnosis of juvenile-adult form of neuroaxonal dystrophy by electron microscopy of rectum and skin biopsy.

The morphological studies of muscle biopsy specimens have shown normal5 6 or non-specific changes' in the reported cases. We studied immunohistochemical localisation of myoglobin in biopsied muscles. Myoglobin, a small molecule (17,000 daltons), is a soluble protein and is found abundantly in cardiac and skeletal muscles. Serum myoglobin increase with muscle cell damage, and it is a more sensitive indicator than CK activity.9 Sidney et al1° have shown using an indirect immunofluorescent technique that myoglobin disappears from cardiac muscle fibres and appears only in the interstitial spaces after 30 minutes of ligation of a coronary artery. Interestingly, immunohistochemical study of our case revealed that some muscle fibres, mainly small atrophic fibres, were negative for myoglobin stain in contrast with positive stain of the remaining fibres. This suggests that hypocalcaemia may lead to myoglobin leakage from skeletal muscles. With respect to the experimental data of Streffer et al, 1I who demonstrated the leakage of cellular enzymes in calcium-free media, Kruse et al6 suggested that hypocalcaemia may lead to reversible alterations in enzyme contents of skeletal muscles without structural changes. Finally, our findings indicate that hypocalcaemic myopathy is a distinct clinical entity.