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Am J Hematol. 2005 Apr;78(4):306-9.

Hydroxychloroquine causes severe vacuolar myopathy in a patient with chronic graft-versus-host disease.

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Department of Oncology, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.


A 51-year-old man developed progressive debilitating limb and respiratory muscle weakness while undergoing treatment for chronic graft-versus-host disease secondary to allogeneic bone marrow transplant for mantle cell lymphoma. He had a normal serum creatine kinase level and acetylcholine receptor antibodies were negative. Electromyography showed a severe, nonirritable myopathy and a sensory motor axonal polyneuropathy. A muscle biopsy showed a necrotizing, vacuolar myopathy with many fibers containing autophagic and red-rimmed vacuoles, suggestive of an amphiphilic drug myopathy. The patient's strength and function improved significantly after discontinuation of hydroxychloroquine.

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