Spontaneous Remission Of Isaacs’ Syndrome

Abstract

An 18-year-old man presented with generalized body ache, muscle cramps, weight loss, and painful muscle twitching in his lower extremities.His symptoms aggravated with physical exertion.There was an increased sweating on his limbs and trunk.His medical history was notable for lichen planus.He was a nonsmoker and did not use illicit drugs.Family history was insignificant.On examination, fasciculations on his lower extremities were observed (Video 1).Consciousness, mental state, tone, power, reflexes, senses, cerebellar signs, and cranial nerves on examination were normal.Laboratory investigations of the patient revealed elevated muscle enzymes: creatine phosphokinase as 922 U/L (0-171 U/L), aspartate aminotransferase as 85 U/L (0-50 U/L), and alanine aminotransferase as 157 U/L (0-50 U/L).Serum electrolytes, thyroid hormone, calcium, phosphate, and vitamin D levels were normal.The expression of anti-nuclear, antineutrophil cytoplasmic, and extractable nuclear antibodies was negative.Magnetic resonance imaging showed no evidence of myositis, and the cranial magnetic resonance imaging was normal.A written informed consent was obtained from the patient.Nerve conduction studies revealed normal electrophysiological findings.However, a decremental response to repetitive nerve