Two cases of glutaric aciduria type II: how to differentiate from inflammatory myopathies?

Acta Clin Belg. 2019 Dec;74(6):451-455. doi: 10.1080/17843286.2018.1547244. Epub 2018 Nov 19.


Muscle weakness is a nonspecific finding of myopathy of any etiology that include iatrogenic, toxic, endocrinological, infectious, immunologic, and metabolic disorders. Among the metabolic myopathies glutaric aciduria type II (GAII) is an autosomal recessively inherited rare disorder of fatty acid and amino acid metabolisms. The late onset form is heterogeneous in terms of symptomatology and severity and for the cases that chronic manifestations of lipid storage myopathy are the only clues for the disease, differential diagnosis can be challenging. Here we report two cases of GAII: the first one was 18-year old boy who presented with proximal muscle weakness and in another center, he was diagnosed as polymyositis and treated with immunosuppressive therapies. He admitted to our clinic with ongoing muscle weakness and symptoms that were related to the side effects of immunosuppressive therapies. The second case was also presented with muscle weakness. For both cases, muscle biopsies and urinary organic acid analyses were consistent with the diagnosis of GAII. To differentiate inflammatory myositis from non-inflammatory myopathies; rheumatic symptoms, accompanying complaints of the patient and autoantibody positivity can be helpful. To our knowledge this is the first report to underline the differential diagnosis of inflammatory myopathies from metabolic myopathies.

Keywords: Myositis; glutaric acidemia type II; lipid storage myopathy; metabolic; multiple acyl-coenzyme A deficiency.

Publication types

  • Case Reports

MeSH terms

  • Acyl-CoA Dehydrogenase / deficiency*
  • Adolescent
  • Biopsy / methods
  • Carnitine / administration & dosage
  • Diagnosis, Differential
  • Female
  • Humans
  • Late Onset Disorders* / diagnosis
  • Late Onset Disorders* / physiopathology
  • Lipid Metabolism, Inborn Errors* / diagnosis
  • Lipid Metabolism, Inborn Errors* / etiology
  • Lipid Metabolism, Inborn Errors* / physiopathology
  • Male
  • Micronutrients / administration & dosage
  • Multiple Acyl Coenzyme A Dehydrogenase Deficiency* / diagnosis
  • Multiple Acyl Coenzyme A Dehydrogenase Deficiency* / metabolism
  • Multiple Acyl Coenzyme A Dehydrogenase Deficiency* / physiopathology
  • Muscle Weakness / diagnosis
  • Muscle Weakness / etiology
  • Muscle, Skeletal / pathology*
  • Muscular Dystrophies* / diagnosis
  • Muscular Dystrophies* / etiology
  • Muscular Dystrophies* / physiopathology
  • Myositis / diagnosis*
  • Riboflavin / administration & dosage
  • Severity of Illness Index
  • Urinalysis / methods
  • Young Adult


  • Micronutrients
  • Acyl-CoA Dehydrogenase
  • Carnitine
  • Riboflavin

Supplementary concepts

  • Myopathy with Abnormal Lipid Metabolism