This article has no abstract; the first 100 words appear below.

Presentation of Case

Dr. Ian J. Barbash (Medicine): A 37-year-old man was admitted to this hospital because of muscle pain and weakness.

The patient had been well until the evening before admission, when mild diffuse myalgias developed. He awoke in the morning with diffuse muscle cramps and intense pain in his legs (he rated the pain at 10 on a scale of 1 to 10, with 10 indicating the most severe pain). On arising to go to the bathroom, he felt unsteady and had difficulty walking. After returning to bed, diffuse muscle pain persisted, with weakness in his arms and . . .

This case was discussed at the Medicine Case Conference.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

No potential conflict of interest relevant to this article was reported.

We thank Drs. Geren Stone, Leigh Simmons, Jason Faris, Hasan Bazari, and Lloyd Axelrod for assistance with organizing the conference; and Drs. Scott B. Vafai, Gilbert H. Daniels, Karen Klahr Miller, and Keith Marill for assistance with preparing the case history.

Source Information

From the Division of Nephrology, Department of Medicine (E.P.R.), and the Departments of Radiology (J.A.S.), and Pathology (A.S.D.), Massachusetts General Hospital; and the Departments of Medicine (E.P.R.), Radiology (J.A.S.), and Pathology (A.S.D.), Harvard Medical School — both in Boston.

Read more: