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Muscle contraction is caused by electrophysiologic activity, whereas electrically silent myofiber shortening, physiologic contracture, occurs in varied situations including metabolic failure and calcium-ATPase deficiency. In one clinically fascinating form of physiologic contracture, rippling muscle (RM), mechanical stimuli cause electrically silent waves to propagate across a muscle.1,2⇓ RM can be dominantly inherited, as in families with caveolin mutations,3 or can develop in patients with myasthenia gravis.4,5⇓ We report RM in a patient with autoimmune hemolytic anemia, but without either thymoma or a neuromuscular junction disorder. This patient demonstrates that acquired RM can occur in association with non-neurologic autoimmune disease.
Case report.
A 60-year-old man of Irish and Polish descent had no neuromuscular symptoms, normal muscle bulk, normal strength, and no abnormal cramping until 2 years before evaluation, when he noted episodic localized tightening and rippling of muscles, sometimes producing involuntary limb twitches and impaired fine motor control. Physical exertion caused …
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