Muscle histochemistry in chronic alcoholism

Ferraz, M. L.; Gabbai, A. A.; Oliveira, A. S. B.; Ferrari, A. P. J.; Miszputen, S. J.; Ferreira Neto, A.; Castelo Filho, A.; Schmidt, B.

doi:10.1590/S0004-282X1989000200003

Abstracts

Twenty-two chronic acoholic patients were assessed by neurologic examination and muscle biopsy. The patients manifested proximal muscular weakness to a variable extent. One case presented as an acute bout of myopathy, according to the Manual Muscle Test, MMT. The most prominent histologic feature observed was muscle atrophy (95.3%) better evidenced through the ATPase stain with the predominance of type II A fibers (71.4%). Lack of the mosaic pattern (type grouping) seen in 76% of the cases and an important mitochondrial proliferation with intrasarcoplasmatic lipid accumulation in 63% of the patients. In case of acute presentation of muscle weakness the. pathological substrate is quite different, i.e. presence of myositis mainly interstitial characterized by lymphoplasmocytic infiltrate and several spots of necrosis like Zencker degeneration. Based on histologic criteria, our data suggest that: the main determinant of muscle weakness seen in chronic alcoholic patients is neurogenic in origin (alcoholic polineuropathy); the direct toxic action of ethanol under the skeletal muscle is closely related to the mitochondrial metabolism; the so-called acute alcoholic myopathy has probably viral etiology.

Vinte e dois pacientes alcoólatras crônicos foram submetidos a exame clínico neurológico e biópsia muscular. Eles apresentavam graus variáveis de fraqueza muscular proximal (cinturas escapular e pélvica), tendo um deles evoluído com quadro agudo de miopatia (avaliação pelo 'Manual Muscle Test', MMT). A principal alteração histológica observada é melhor evidenciada pela coloração da ATPase: atrofia muscular (95,3%), predominando nas fibras do tipo II A (71,4%) e, em 76% dos casos, alteração da imagem em mosaico à custa de agrupamentos de fibras musculares de mesmo tipo histoquímico ('type-grouping'). Secundariamente, em 63% dos casos, observa-se proliferação mitocondrial e conseqüente acúmulo lipídico intra-sarcoplasmático. No caso de instalação aguda da fraqueza muscular, o substrato anátomo-patológico é completamente diferente: presença de mlosite, predominantemente intersticial, caracterizada por infiltrado linfoplasmocitário e numerosas imagens de necrose tipo degeneração cérea de Zencker. Baseando-se em critérios histológicos, nossos dados sugerem que: a principal gênese da fraqueza muscular observada em pacientes alcoólatras crônicos tem natureza neurogênica (polineuropatia alcoólica); a atuação tóxica direta do etanol sobre o músculo esquelético está intimamente relacionada ao metabolismo mitocondrial; a chamada miopatia aguda alcoólica tenha etiologia inflamatória, do tipo viral.

Estudo histoquímico do músculo esquelético no alcoolismo crônico

Muscle histochemistry in chronic alcoholism

M. L. Ferraz^I; A. A. Gabbai^II; A. S. B. Oliveira^III; A. P. J. Ferrari^I; S. J. Miszputen^IV; A. Ferreira Neto^V; A. Castelo Filho^VI; B. Schmidt^II

^IDisciplina de Neurologia (DN) e na Disciplina de Gastroenterologia Clínica (DGC) da Escola Paulista de Medicina (EPM): Pós Graduando, DGC

^IIDisciplina de Neurologia (DN) e na Disciplina de Gastroenterologia Clínica (DGC) da Escola Paulista de Medicina (EPM): Responsável pelo Setor de Patologia Neuromuscular, DN, EPM

^IIIDisciplina de Neurologia (DN) e na Disciplina de Gastroenterologia Clínica (DGC) da Escola Paulista de Medicina (EPM): Pós Graduando, DN

^IVDisciplina de Neurologia (DN) e na Disciplina de Gastroenterologia Clínica (DGC) da Escola Paulista de Medicina (EPM):Professor Adjunto da DGC

^VDisciplina de Neurologia (DN) e na Disciplina de Gastroenterologia Clínica (DGC) da Escola Paulista de Medicina (EPM): Médico Residente, DN, EPM

^VIDisciplina de Neurologia (DN) e na Disciplina de Gastroenterologia Clínica (DGC) da Escola Paulista de Medicina (EPM): Professor Adjunto e Chefe da Disciplina de Moléstias Infecciosas e Parasitárias, EPM

RESUMO

Vinte e dois pacientes alcoólatras crônicos foram submetidos a exame clínico neurológico e biópsia muscular. Eles apresentavam graus variáveis de fraqueza muscular proximal (cinturas escapular e pélvica), tendo um deles evoluído com quadro agudo de miopatia (avaliação pelo 'Manual Muscle Test', MMT). A principal alteração histológica observada é melhor evidenciada pela coloração da ATPase: atrofia muscular (95,3%), predominando nas fibras do tipo II A (71,4%) e, em 76% dos casos, alteração da imagem em mosaico à custa de agrupamentos de fibras musculares de mesmo tipo histoquímico ('type-grouping'). Secundariamente, em 63% dos casos, observa-se proliferação mitocondrial e conseqüente acúmulo lipídico intra-sarcoplasmático. No caso de instalação aguda da fraqueza muscular, o substrato anátomo-patológico é completamente diferente: presença de mlosite, predominantemente intersticial, caracterizada por infiltrado linfoplasmocitário e numerosas imagens de necrose tipo degeneração cérea de Zencker. Baseando-se em critérios histológicos, nossos dados sugerem que: a principal gênese da fraqueza muscular observada em pacientes alcoólatras crônicos tem natureza neurogênica (polineuropatia alcoólica); a atuação tóxica direta do etanol sobre o músculo esquelético está intimamente relacionada ao metabolismo mitocondrial; a chamada miopatia aguda alcoólica tenha etiologia inflamatória, do tipo viral.

SUMMARY

Twenty-two chronic acoholic patients were assessed by neurologic examination and muscle biopsy. The patients manifested proximal muscular weakness to a variable extent. One case presented as an acute bout of myopathy, according to the Manual Muscle Test, MMT. The most prominent histologic feature observed was muscle atrophy (95.3%) better evidenced through the ATPase stain with the predominance of type II A fibers (71.4%). Lack of the mosaic pattern (type grouping) seen in 76% of the cases and an important mitochondrial proliferation with intrasarcoplasmatic lipid accumulation in 63% of the patients. In case of acute presentation of muscle weakness the. pathological substrate is quite different, i.e. presence of myositis mainly interstitial characterized by lymphoplasmocytic infiltrate and several spots of necrosis like Zencker degeneration. Based on histologic criteria, our data suggest that: the main determinant of muscle weakness seen in chronic alcoholic patients is neurogenic in origin (alcoholic polineuropathy); the direct toxic action of ethanol under the skeletal muscle is closely related to the mitochondrial metabolism; the so-called acute alcoholic myopathy has probably viral etiology.

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Dr. Acary S. Bulle Oliveira - Setor de Patologia Neuromuscular, Disciplina de Neurologia, Escola Paulista de Medicina - Rua Botucatu 740 - 04023 São Paulo SP - Brasil.

1. Blachley JD, Ferguson ER, Carter NW, Knochel JP - Chronic alcohol ingestion induces phosphorus deficiency and myopathy in the dog. Trans Assoc Am Phys 93:110, 1980.
2. Del Villar Negro A, Rivera Pomar JM - Skeletal muscle changes in chronic alcoholics patients: a conventional histochemical, ultrastructural and morphometric study. Acta Neurol Scandl 70:185, 1984.
3. Douglas RM, Fewings JD, Casley-Smith JR - Recurrent rhabdomyolysis precipitated by alcohol: a case report with physiological and electron microscopic studies of skeletal muscle. Aust Ann Med 15:251, 1966.
4. Dubowitz V, Brooke MH - Muscle biopsy: a modern approach. Saunders, New York, 1973.
5. Faris AA, Reyes MG - Reappraisal of alcoholic myopathy: clinical and biopsy study on chronic alcoholics without muscle weakness or wasting. J Neurol Neurosurg Psychiat 34: 86, 1971.
6. Haller RG, Drachman DB - Alcoholic rhabdomyolisis: an experimental model in rat. Science 208: 412, 1980.
7. Haller RG, Knochel JP - Experimental alcoholic rhabdomyolysis: a histological study. J Neuropathol Exp Neurol 39:358, 1980.
8. Hanid A, Slavin G, Muir W - Fiber type changes in striated muscle of alcoholics. J Clin Pathol 34:991, 1981.
9. Hed R, Larrson H, Wahlgren F - Acute myoglobinuria in alcoholism. Acta Med Scand 152: 1459, 1955.
10. Jackson J - On a peculiar disease resulting from the use of ardente spiritis. N Engl J Med Surg 11:351, 1822.
11. Jones JE, Shane SR, Jacobs WH, Flink EB - Magnesium balance studies in chronic alcoholism. Ann NY Acad Sci 162:934, 1969.
12. Kahn LB, Meyer JS - Acute myopathy in chronic alcoholism. Am J Clin Pathol 53:516, 1970.
13. Kiessling KH, Pilstrom L, Karlsson J, Piehl K - Mitochondrial volume in skeletal muscle from young and old physically untrained and trained healthy men and alcoholics. Science 44: 547, 1973.
14. Klinkerfuss G, Bleisch V, Diogo MM, Perkoff GT - A spectrum of myopathy associated with alcoholism: II. Light and electron microscopic observations. Ann Intern Med 67: 493, 1967.
15. Knochel JP, Bilbrey GL, Fuller TJ - The muscle cell in chronic alcoholism myopathy. Ann NY Acad Sci 252: 274, 1975.
16. Knutsson E, Katz S - The effect of ethanol on the membrane permeability to sodium and potassium ions in frog muscle fibers. Acta Pharmacol 25:54, 1967.
17. Koffler A, Friedler RM, Massry SG - Acute renal failure due to nontraumatic rhabdomyolisis. Ann Intern Med 85:23, 1976.
18. Kugelberg E, Welander L - Heredofamilial juvenile, muscular atrophy simulating muscular dystrophy. Arch Neurol Psychiat 75: 500, 1956.
19. Lettsom JC - Some remarks on the effects of lignum quassiae amarae. Memoirs Med Soc Lond 1:128, 1787.
20. Martin FC, Slavin G, Levin AJ, Peters TJ - Investigation of the organelle pathology of skeletal muscle in chronic alcoholism. J Clin Pathol 37:448, 1984.
21. Martin F, Warp K, Slavin G, Levis J, Peters TJ - Alcoholic skeletal myopathy, a clinical and pathological study. Quart J Med 218: 233, 1985.
22. Martinez AJ, Hooshmand H, Faris AA - Acute alcoholic myopathy: enzyme histochemistry and electron microscopy findings. J Neurol Sci 20:245, 1973.
23. Oh SJ - Alcoholic myopathy. Ann Rev Med 22: 125, 1971.
24. Perkoff GT, Hardy P, Vélez Garcia E - Reversible acute muscular syndrome in chronic alcoholism. N Engl J Med 274: 1277, 1966.
25. Rubenstein AE, Wainapel SF - Acute hipok 'emic myopathy in alcoholism, a clinical entity. Arch Neurol 34: 553, 1977.
26. Rubin E - Alcoholic myopathy in heart and skeletal muscle. N Engl J Med 301: 28, 1979.
27. Rubin E, Katz AM, Lieber CS, Stein EP, Puzskin S - Muscle damage produced by chronic alcohol consumption. Am J Pathol 83:499, 1976.
28. Rossouw JE, Keeton RG, Hewlett RH - Chronic proximal muscular weakness in alcoholics. S Afr Med J 50:2095, 1976.
29. Schmidt B, Diament D, Gabbai AA, Saad FA - Lesions musculaires de la maladie de Weil (leptospirosis). 2ème Réunion du Club Français de Neuropathologie, Paris, 1984.
30. Schmidt B, Gabbai AA - A biópsia muscular em pediatria: Apresentação de 320 casos estudados através de nova metodologia, 'a dança dos farabeufs'. SLAIP XXIV, XXIV Reunião Anual 9, 1986.
31. Schmidt B, Gabbai AA, Oliveira ASB, Braga MB Jr, Castelo-Filho A, Laredo J Filho - Biópsia muscular: nova metodologia, 'a dança dos farabeufs'. Rev Bras Ortop 23:21, 1988.
32. Song SK, Rubin E - Ethanol produces muscle damage in human volunteers. Science 175: 327, 1972.
33. Stuart BM, Puilen RL - Thyroid: clinical analyses of 360 cases. Arch Intern Med 78: 629. 1946
34. Victor M - Toxic and nutritional myopathies. In Engel AG, Banker BQ (eds): Myology, Basic and Clinical. Vol 2 McGraw-Hill, San Francisco, 1987, pg 1807.

Publication Dates

Publication in this collection
06 June 2011
Date of issue
June 1989

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Blachley JD, Ferguson ER, Carter NW, Knochel JP - Chronic alcohol ingestion induces phosphorus deficiency and myopathy in the dog. Trans Assoc Am Phys 93:110, 1980.

[2] 2. Del Villar Negro A, Rivera Pomar JM - Skeletal muscle changes in chronic alcoholics patients: a conventional histochemical, ultrastructural and morphometric study. Acta Neurol Scandl 70:185, 1984.

[3] 3. Douglas RM, Fewings JD, Casley-Smith JR - Recurrent rhabdomyolysis precipitated by alcohol: a case report with physiological and electron microscopic studies of skeletal muscle. Aust Ann Med 15:251, 1966.

[4] 4. Dubowitz V, Brooke MH - Muscle biopsy: a modern approach. Saunders, New York, 1973.

[5] 5. Faris AA, Reyes MG - Reappraisal of alcoholic myopathy: clinical and biopsy study on chronic alcoholics without muscle weakness or wasting. J Neurol Neurosurg Psychiat 34: 86, 1971.

[6] 6. Haller RG, Drachman DB - Alcoholic rhabdomyolisis: an experimental model in rat. Science 208: 412, 1980.

[7] 7. Haller RG, Knochel JP - Experimental alcoholic rhabdomyolysis: a histological study. J Neuropathol Exp Neurol 39:358, 1980.

[8] 8. Hanid A, Slavin G, Muir W - Fiber type changes in striated muscle of alcoholics. J Clin Pathol 34:991, 1981.

[9] 9. Hed R, Larrson H, Wahlgren F - Acute myoglobinuria in alcoholism. Acta Med Scand 152: 1459, 1955.

[10] 10. Jackson J - On a peculiar disease resulting from the use of ardente spiritis. N Engl J Med Surg 11:351, 1822.

[11] 11. Jones JE, Shane SR, Jacobs WH, Flink EB - Magnesium balance studies in chronic alcoholism. Ann NY Acad Sci 162:934, 1969.

[12] 12. Kahn LB, Meyer JS - Acute myopathy in chronic alcoholism. Am J Clin Pathol 53:516, 1970.

[13] 13. Kiessling KH, Pilstrom L, Karlsson J, Piehl K - Mitochondrial volume in skeletal muscle from young and old physically untrained and trained healthy men and alcoholics. Science 44: 547, 1973.

[14] 14. Klinkerfuss G, Bleisch V, Diogo MM, Perkoff GT - A spectrum of myopathy associated with alcoholism: II. Light and electron microscopic observations. Ann Intern Med 67: 493, 1967.

[15] 15. Knochel JP, Bilbrey GL, Fuller TJ - The muscle cell in chronic alcoholism myopathy. Ann NY Acad Sci 252: 274, 1975.

[16] 16. Knutsson E, Katz S - The effect of ethanol on the membrane permeability to sodium and potassium ions in frog muscle fibers. Acta Pharmacol 25:54, 1967.

[17] 17. Koffler A, Friedler RM, Massry SG - Acute renal failure due to nontraumatic rhabdomyolisis. Ann Intern Med 85:23, 1976.

[18] 18. Kugelberg E, Welander L - Heredofamilial juvenile, muscular atrophy simulating muscular dystrophy. Arch Neurol Psychiat 75: 500, 1956.

[19] 19. Lettsom JC - Some remarks on the effects of lignum quassiae amarae. Memoirs Med Soc Lond 1:128, 1787.

[20] 20. Martin FC, Slavin G, Levin AJ, Peters TJ - Investigation of the organelle pathology of skeletal muscle in chronic alcoholism. J Clin Pathol 37:448, 1984.

[21] 21. Martin F, Warp K, Slavin G, Levis J, Peters TJ - Alcoholic skeletal myopathy, a clinical and pathological study. Quart J Med 218: 233, 1985.

[22] 22. Martinez AJ, Hooshmand H, Faris AA - Acute alcoholic myopathy: enzyme histochemistry and electron microscopy findings. J Neurol Sci 20:245, 1973.

[23] 23. Oh SJ - Alcoholic myopathy. Ann Rev Med 22: 125, 1971.

[24] 24. Perkoff GT, Hardy P, Vélez Garcia E - Reversible acute muscular syndrome in chronic alcoholism. N Engl J Med 274: 1277, 1966.

[25] 25. Rubenstein AE, Wainapel SF - Acute hipok 'emic myopathy in alcoholism, a clinical entity. Arch Neurol 34: 553, 1977.

[26] 26. Rubin E - Alcoholic myopathy in heart and skeletal muscle. N Engl J Med 301: 28, 1979.

[27] 27. Rubin E, Katz AM, Lieber CS, Stein EP, Puzskin S - Muscle damage produced by chronic alcohol consumption. Am J Pathol 83:499, 1976.

[28] 28. Rossouw JE, Keeton RG, Hewlett RH - Chronic proximal muscular weakness in alcoholics. S Afr Med J 50:2095, 1976.

[29] 29. Schmidt B, Diament D, Gabbai AA, Saad FA - Lesions musculaires de la maladie de Weil (leptospirosis). 2ème Réunion du Club Français de Neuropathologie, Paris, 1984.

[30] 30. Schmidt B, Gabbai AA - A biópsia muscular em pediatria: Apresentação de 320 casos estudados através de nova metodologia, 'a dança dos farabeufs'. SLAIP XXIV, XXIV Reunião Anual 9, 1986.

[31] 31. Schmidt B, Gabbai AA, Oliveira ASB, Braga MB Jr, Castelo-Filho A, Laredo J Filho - Biópsia muscular: nova metodologia, 'a dança dos farabeufs'. Rev Bras Ortop 23:21, 1988.

[32] 32. Song SK, Rubin E - Ethanol produces muscle damage in human volunteers. Science 175: 327, 1972.

[33] 33. Stuart BM, Puilen RL - Thyroid: clinical analyses of 360 cases. Arch Intern Med 78: 629. 1946

[34] 34. Victor M - Toxic and nutritional myopathies. In Engel AG, Banker BQ (eds): Myology, Basic and Clinical. Vol 2 McGraw-Hill, San Francisco, 1987, pg 1807.