A 65-year-old Caucasian woman presented with insidious onset of symmetric bilateral lower and upper limb weakness, which progressed slowly over the last 3 years. The pattern of weakness was mainly proximal, with some minimal to mild distal weakness evolving in recent months. She also developed some tingling and numbness in her toes followed by fingertips over the last year. Is plaquenil a maoi Lisinopril and plaquenil What happens if you stop plaquenil Chloroquine dose in renal failure Chloroquine Hydroxychloroquine-induced cardiomyopathy is a rare but potentially life-threatening condition. Cessation of the culprit drug, along with aggressive afterload reduction therapy, has been associated with halting of disease progress and even improvement in patients' clinical and histologic status. The biceps brachii in the upper extremity and the quadriceps in the lower extremity are preferred as they are less likely to be injected or otherwise injured, and their orientation of muscle is more suitable for examination. Muscles tested by EMG in the preceding month should be avoided. Hydroxychloroquine sulfate is a chloroquine derivative in which 1 of the N-ethyl groups is β-hydroxylated. Its therapeutic action against falciparum malaria is similar to that of chloroquine. Its therapeutic action against falciparum malaria is similar to that of chloroquine. This was attributed to pericarditis based on workup at an outside facility. She unintentionally lost 20 pounds since the onset of weakness. Approximately 3 years ago, the patient had an episode of chest pain lasting several days. Hydroxychloroquine myopathy pathology Toxic Myopathies, Muscle Pathology Overview – Therapath Neuropathology Plaquenil dose for discoid lupusHydroxychloroquine and gasMarine chloroquine phosphatePlaquenil for autoimmune hepatitisImages early plaquenil toxicity fundus autoflurouecense Hydroxychloroquine sulfate was found to be less toxic than chloroquine and equally effective for treatment of the same disorders. Hydroxychloroquine is also a 4-aminoquinoline compound similar in structure to chloroquine. Hydroxychloroquine differs from chloroquine by the presence of a single hydroxyl group at the end of the side chain Figure 4. Chloroquine neuromyotoxicity. Clinical and pathologic.. Effectiveness of Chloroquine and Hydroxychloroquine in.. Severe hydroxychloroquine myopathy - Abdel‐Hamid - 2008.. Chloroquine and hydroxychloroquine, commonly used for rheumatologic conditions, are rare yet very important causes of toxic myopathy with vacuolar changes on muscle biopsy. Pompe disease, a glycogenosis due to deficiency of lysosomal acid α-glucosidase GAA, may sometimes show similar yet less marked changes on muscle histopathology. A woman with systemic lupus erythematosus developed severe myopathy after a septicemic episode, and her treatment before admission was hydroxychloroquine sulfate and prednisolone. Pathology Axonal loss; Distal Recovery Better in mildly affected More common in patients with skin hyperkeratosis Myopathy Arsenic trioxide Arsine gas Hemolysis Long term Carcinogen, Lung, skin, liver, kidney & bladder Pathophysiology Uncouples oxidative phosphorylation Trivalent As +++ more toxic.