Exertional myalgia may be due to a variety of neuromuscular diseases including glycolytic enzyme defects, carnitine palmityl transferase deficiency, mitochondrial myopathies and Becker muscular dystrophy. In few cases it was associated with neuromyopathy and internalized capillaries. The latter have also been reported in a variety of neuromuscular disorders. We report a patient with the latter condition in whom extensive investigations revealed no underlying neuromuscular disease. He responded dramatically to steroids on two occasions. This syndrome of myalgia, neuromyopathy and internalized capillaries should be added to the list of steroid responsive myalgias.