Hydroxychloroquine Myopathy
Hydroxychloroquine Myopathy
Scattered muscle fibers with: Vacuoles; Aggregates; Basophilic cytoplasm; Small size
![](../pics/biopsy/hcq/hcqhelp.jpg)
H&E stain
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![](../pics/biopsy/hcq/hcqvachehp3.jpg)
H&E stain
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Muscle fibers
Vacuoles
May be internally clear, or contain basophilic aggregatesd material
May be
Acid phosphatase positive
May contain:
Lipofuscin-like granules;
Granular material
Internal nuclei
LAMP2 granules
![](../pics/biopsy/hcq/hcqhehp4.jpg)
H&E stain
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![](../pics/biopsy/hcq/hcqvache.jpg)
H&E stain
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Muscle fibers
Vacuoles
![](../pics/biopsy/hcq/hcqvache2.jpg)
H&E stain
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Muscle fibers
3 small muscle fibers with vacuoles & red staining of cytoplasm.
Fiber sizes: Intermediate to Very small
Vacuoles
Borders: Irregular
May contain: Aggregates; Clustered & lipofuscin-like material
![](../pics/biopsy/hcq/hcqvacgthp.jpg)
Gomori Trichrome stain
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![](../pics/biopsy/hcq/hcqvacvvghp.jpg)
VvG stain
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Muscle fibers
Vacuoles: Gray-Black rims & Aggregates
![](../pics/biopsy/hcq/hcqvacvvghp2.jpg)
VvG stain
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Lipofuscin-like material: In vacuoles & cytoplasm
![](../pics/biopsy/hcq/hcqcrmr.jpg)
Congo red stain
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![](../pics/biopsy/hcq/hcqcrhp3.jpg)
Congo red stain
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Muscle fibers
Vacuoles: Contain lipofuscin-like material
![](../pics/biopsy/hcq/hcqcrhp2.jpg)
Congo red stain
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![](../pics/biopsy/hcq/hcqestmp.jpg)
Esterase stain
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Muscle fibers
Vacuoles: Contain lipofuscin-like material
![](../pics/biopsy/hcq/hcqest.jpg)
Esterase stain
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Lysosomal material in muscle fibers: Acid phosphatase & LAMP-2 staining
![](../pics/biopsy/hcq/hcqacp3.jpg)
Acid phosphatase stain
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![](../pics/biopsy/hcq/hcqacp1.jpg)
Acid phosphatase stain
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![](../pics/biopsy/hcq/hcqacp4.jpg)
Acid phosphatase stain
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![](../pics/biopsy/hcq/hcqacphp1.jpg)
Acid phosphatase stain
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Acid phosphatase+ Regions
Location: Present in vacuoles & cytoplasm
![](../pics/biopsy/hcq/hcqacphp2.jpg)
Acid phosphatase stain
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LAMP-2 stained organelles
![](../pics/biopsy/hcq/hcqlamp2.jpg)
LAMP2 stain
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Aggregates in muscle fibers
![](../pics/biopsy/hcq/hcqtb.jpg)
Toluidine blue stain
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Hydroxychloroquine Myopathy: Ultrastructure
Aggregates: Contain Heterogeneous Material
Membrane-bound vacuoles
Curvilinear bodies
Degradation products
Lipid & Lipofuscin structures
Membranous whorls
Mitochondria
![](../pics/biopsy/hcq/hchlorqemlp1.jpg)
From: R Schmidt
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Curvilinear bodies (Arrow)
Lysosome-derived cytoplasmic inclusions
Also occur in
ceroid lipofuscinosis
![](../pics/biopsy/hcq/clbodies.jpg)
From: J Chen
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Curvilinear bodies & Complex lipid structures with globular elements
![](../pics/biopsy/hcq/clbodies2.jpg)
From: J Chen
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![](../pics/biopsy/hcq/hchlorqem6.jpg)
From: R Schmidt
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![](../pics/biopsy/hcq/hchlorqem8.jpg)
From: R Schmidt
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Complex Lipid Structures
![](../pics/biopsy/hcq/hchlorqem9.jpg)
From: R Schmidt
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![](../pics/biopsy/hcq/hchlorqem10.jpg)
From: R Schmidt
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Autophagic Degradation Products
![](../pics/biopsy/hcq/autophagosomeclbod.jpg)
From: J Chen
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Membranous Whorls
![](../pics/biopsy/hcq/wmb.jpg)
From: J Chen
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![](../pics/biopsy/hcq/hchlorqem5.jpg)
From: R Schmidt
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Membrane-bound vacuoles
? Lysosomal
![](../pics/biopsy/hcq/hchlorqem1.jpg)
From: R Schmidt
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![](../pics/biopsy/hcq/hchlorqem2.jpg)
From: R Schmidt
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![](../pics/biopsy/hcq/hchlorqem3.jpg)
From: R Schmidt
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Hydroxychloroquine Myopathy: Mitochondria
![](../pics/biopsy/hcq/hchlorqem7.jpg)
From: R Schmidt
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Neuropathy: Hydroxychloroqine-associated
![](../pics/biopsy/hcq/hydchloroquinepntb1.jpg)
Toluidine blue stain
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Neuropathy
Large axons
Loss
Thinly myelinated
Regenerating axon clusters
Endoneurial vessels: Thick walls
![](../pics/biopsy/hcq/hydchloroquinepntb2.jpg)
Toluidine blue stain
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Return to
Hydroxychloroquine myopathy
Return to
Muscle biopsies
12/8/2021