Necrotising myopathy is a progressive inflammatory muscle disease characterised histologically by necrotic and regenerative fibres with or without cell infiltrate. Patients usually present with progressive proximal weakness. Some report dysphagia and or dyspnoea. We are presenting four cases of necrotising myopathy (all females, ages 30–80) where there is no past medical history or past medication as possible aetiology. All cases had greatly elevated CK's (>4000), EMG showing active myositic changes and muscle biopsy results confirming a diagnosis of necrotising muscle disease. Two patients had breathlessness, one of which had marked intercostal and diaphragmatic involvement. Breathlessness, then, should be considered a feature of necrotising myopathy and, hence, a tool for an accurate working diagnosis.
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