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Rippling muscles as a diagnostic clue to thymoma
  1. Arne Hostens1,2,
  2. Wietse Wiels1,
  3. Gert Cypers1
  1. 1 Neurology, Onze Lieve Vrouwziekenhuis, Aalst, Belgium
  2. 2 Neurology, University Hospital Brussels, Brussels, Belgium
  1. Correspondence to Dr Gert Cypers, neurology, Onze Lieve Vrouwziekenhuis, Aalst, Belgium; gert.cypers{at}gmail.com

https://doi.org/10.1136/pn-2023-004018

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    A 36-year-old man reported 9 months of stiff muscles, muscle aches and ‘cramps’. He described involuntary muscle movements, without weakness, posturing or tremor.

    On examination, there were unusual, wave-like muscle contractions on stretching of the leg (video 1) and after percussing the leg muscles (video 2). There was no muscle atrophy or hypertrophy and no bradykinesia.

    Video 1 Indentation of thigh musculature of the right leg, corresponding to a moving wave front induced by stretching.
    Video 2 Indentation of thigh musculature of the left leg, corresponding to a moving wave front induced by percussion.

    We diagnosed rippling muscle disease. This is a rare muscle syndrome usually caused by a mutation in caveolin-31 but also may be an autoimmune, paraneoplastic feature (eg in thymoma).2 CT scan of the chest (figure 1A) identified a mediastinal mass, subsequently confirmed on positron-emission tomography scanning (figure 1B) . The lesion was resected and pathologically proven to be a WHO type B1 (predominantly cortical) …

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    Footnotes

    • Contributors (1) Research project: A. Conception, B. Organisation, C. Execution; (2) Statistical analysis: A. Design, B. Execution, C. Review and critique; (3) Manuscript: A. Writing of the first draft, B. Review and critique. Author AH: 3A, 3B. Author WW: 3A, 3B. Author GC: 1A, 1B, 1C, 3A, 3B.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed by Jon Walters, Swansea, UK.

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