Myopathies associated with malignancies include polymyositis, Eaton-Lambert syndrome, remote effects, direct invasion, and meta~tasis.'~~~' Skeletal muscles are usually regarded as an uncommon site of secondary tumor growth. We report on an unusual case of a patient with T-cell leukemia showing muscle weakness and extensive leukemic cell infiltration into the skeletal muscles in early onset.
CASEREPORT
A previously healthy 48-year-old male experienced progressive muscle weakness in the lower extremities in the summer of 1981, and subsequently lost 4 kg in weight. Owing to muscle weakness and abnormal laboratory findings he was admitted to a local hospital in November 1982, and was transferred to the department of internal medicine in our hospital suspected of leukemia in January 1983. Hepatosplenomegaly was noted on physical examination, and was referred to us for neurological evaluation.
Neurological examinations disclosed mild to moderate symmetrical proximal dominant weakness in four extremities with slight muscle atrophy. Gowers' sign was present. Deep tendon reflex was normal, and pathologic reflex was not observed. Cranial nerves were intact. Sensory disturbances, cerebellar signs, and urinary dysfunction were not observed.
Laboratory Studies. Laboratory studies found red blood cell count 421 X 104/mm', platelets 7000/ mm3, and white blood cell count 30,900/mm3 (T-