Desminopathy presenting as late onset bilateral facial weakness, with diagnosis supported by lower limb MRI

Neuromuscul Disord. 2021 Mar;31(3):249-252. doi: 10.1016/j.nmd.2020.12.013. Epub 2021 Jan 8.


A 63 year old male presented with a 20 year history of facial weakness and several years of nasal regurgitation and dysphonia. Examination revealed bilateral facial weakness with nasal speech. Serum creatine kinase was 918 U/L. Neurophysiological studies suggested a myopathy and biopsy of the left vastus lateralis showed serpentine basophilic inclusions in the sarcoplasm and strong oxidative enzyme activity suggesting mitochondria accumulation. The muscle MRI showed selective fatty replacement within semitendinosus, gastrocnemius and soleus indicative of a desminopathy. A heterozygous missense variant c.17C>G (p.Ser6Trp) was identified within DES, predicted to be pathogenic in silico and previously described in a family with distal limb weakness. There are no previous case reports of desminopathy presenting with facial weakness, to our knowledge. Diagnosis was suggested following myoimaging of clinically unaffected muscles. Our study highlights the importance of muscle MRI in the diagnostic evaluation of muscle disease and further expands the known phenotypic heterogeneity of desminopathies.

Keywords: Biopsy; Desmin; Desminopathy; Facial weakness; Myofibrillar myopathy; Myoimaging.

Publication types

  • Case Reports

MeSH terms

  • Cardiomyopathies / diagnostic imaging*
  • Facial Muscles / diagnostic imaging*
  • Heterozygote
  • Humans
  • Lower Extremity / diagnostic imaging*
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Muscle Weakness / diagnostic imaging*
  • Muscular Dystrophies / diagnostic imaging*
  • Mutation, Missense

Supplementary concepts

  • Myopathy, Myofibrillar, Desmin-Related