On September 2007, a 39 year old male with a known Crohn's disease (CD) was admitted to our department because of longstanding diarrhea, severe fatigue and muscle weakness. The patient was in stable therapy with azathioprine from 2004. On physical examination, he appeared malnourished and showed symmetrical muscle weakness of the proximal muscles of all extremities. Laboratory investigations showed severe hypokalemia (2.1 mmol/L), elevated creatine kinase level (CK 10,246 Ul, CK-MB 35.3 Ul) and increased LDH (886 U/L). Stool cultures and serological viral evaluation excluded active/ recent infections. The autoimmune investigation (ANA, ASAAA) was negative. The neuromuscular work-up comprised both electromyography and muscle biopsy that excluded primitive and muscular diseases so that we made diagnosis of HM complicating CD. The patient underwent intravenous rehydration with potassium supplementation (no other drugs were given) with the complete normalization of CK and LDH levels and significant improvement of muscular symptoms. Azathioprine therapy was not stopped.
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