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Emetine myopathy: two case reports with pathobiochemical analysis.

H Sugie, R Russin, M A Verity

    Muscle & Nerve
    |January 1, 1984
    PubMed
    Summary
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    Emetine hydrochloride, used in aversion therapy, can cause reversible muscle weakness and damage in patients with alcohol abuse. Muscle biopsies revealed characteristic changes, including Z-band streaming and reduced mitochondrial content.

    Area of Science:

    • Neurology
    • Toxicology
    • Muscle Physiology

    Background:

    • Aversion therapy using emetine hydrochloride is employed for alcohol abuse treatment.
    • Alcohol abuse can predispose individuals to certain toxic exposures.
    • Proximal muscle weakness is a concerning symptom requiring investigation.

    Observation:

    • Two female patients with alcohol abuse history developed painful proximal muscle weakness after emetine hydrochloride therapy.
    • Muscle biopsies revealed distinct histopathological changes, including reversible loss of specific enzymes and Z-band streaming.
    • Electron microscopy showed mitochondrial reduction and normal sarcotubular systems.

    Findings:

    • Muscle biopsy in Case 1 demonstrated reversible floccular-shaped loss of myosin ATPase and dehydrogenase, with PAS-positive material accumulation.

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  • Repeat biopsy in Case 1 showed core changes without focal enzyme loss, indicating reversibility.
  • Case 2 exhibited similar, albeit milder, muscle biopsy changes, including Z-band streaming and decreased mitochondria.
  • Implications:

    • Emetine hydrochloride toxicity can manifest as a specific myopathy characterized by reversible enzymatic loss and structural changes.
    • Understanding these myopathic changes is crucial for diagnosing and managing patients undergoing emetine-based aversion therapy.
    • Further research into the precise mechanisms of emetine-induced myopathy and its long-term effects is warranted.