Use of dynamic tests of muscle function and histomorphometry of quadriceps muscle biopsies in the investigation of patients with chronic alcohol misuse and chronic fatigue syndrome. — ME/CFS Atlas
E2 ModeratePreliminaryPEM not requiredCross-SectionalPeer-reviewedReviewed
Standard · 3 min
Use of dynamic tests of muscle function and histomorphometry of quadriceps muscle biopsies in the investigation of patients with chronic alcohol misuse and chronic fatigue syndrome.
Wassif, W S, Sherman, D, Salisbury, J R et al. · Annals of clinical biochemistry · 1994 · DOI
Quick Summary
Researchers tested muscle function and examined muscle samples from people with ME/CFS and people with chronic alcohol problems to see if their muscle problems were similar or different. They found that while some people initially thought to have ME/CFS actually had other conditions (like a rare enzyme deficiency or inflammation), the muscle changes in alcohol misuse were quite distinct and recognizable through muscle biopsies.
Why It Matters
This study demonstrates that dynamic muscle testing and biopsy can help rule out treatable alternative diagnoses that may be misclassified as ME/CFS, including specific enzyme deficiencies and inflammatory myopathies. Accurate differential diagnosis is critical because conditions like myoadenylate deaminase deficiency and polymyositis require different medical management than ME/CFS.
Observed Findings
Basal serum lactate levels were elevated in alcohol misusers but remained within normal range for all participants.
Lactate response profiles to ischaemic exercise were similar between CFS and alcohol misuser groups.
Three patients initially diagnosed with CFS were found to have alternative diagnoses: myoadenylate deaminase deficiency, polymyositis, and myopathy with mild type II fibre atrophy.
Type II fibre atrophy factors were significantly elevated in the alcohol group but within reference range in CFS patients.
Histomorphometric features of chronic alcoholic skeletal myopathy were present in 6 of 10 alcohol misusers.
Inferred Conclusions
Dynamic muscle function tests and muscle histomorphometry are valuable tools for excluding alternative pathology in suspected CFS cases.
Muscle histomorphometry is particularly effective for diagnosing chronic alcoholic myopathy, which produces distinctive microscopic changes.
Some patients presenting with CFS symptoms may have identifiable metabolic or inflammatory muscle disorders requiring alternative treatment.
Remaining Questions
What proportion of patients clinically diagnosed with ME/CFS in the general population harbor these alternative diagnoses?
What This Study Does Not Prove
This study does not establish the underlying cause of muscle dysfunction in ME/CFS itself, nor does it prove that muscle abnormalities are central to ME/CFS pathophysiology. The small sample size and cross-sectional design limit generalizability, and the study cannot determine whether the identified alternative diagnoses represent cases of diagnostic misclassification or comorbidity.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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