Sporadic Late-Onset Nemaline Myopathy: Current Landscape

Curr Neurol Neurosci Rep. 2023 Nov;23(11):777-784. doi: 10.1007/s11910-023-01311-0. Epub 2023 Oct 19.


Purpose of review: Sporadic late-onset nemaline myopathy (SLONM) is a rare adult-onset, acquired, muscle disease that can be associated with monoclonal gammopathy or HIV infection. The pathological hallmark of SLONM is the accumulation of nemaline rods in muscle fibers. We review here current knowledge about its presentation, pathophysiology, and management.

Recent findings: SLONM usually manifests with subacutely progressive proximal and axial weakness, but it can also present with chronic progressive weakness mimicking muscular dystrophy. The pathophysiology of the disease remains poorly understood, with evidence pointing to both autoimmune mechanisms and hematological neoplasia. Recent studies have identified histological, proteomic, and transcriptomic alterations that shed light on disease mechanisms and distinguish SLONM from inherited nemaline myopathies. A majority of SLONM patients respond to intravenous immunoglobulins, chemotherapy, or hematopoietic stem cell transplant. SLONM is a treatable myopathy, although its underlying etiology and pathomechanisms remain unclear. A high degree of suspicion should be maintained for this disease to reduce diagnostic delay and treatment in SLONM and facilitate its distinction from inherited nemaline myopathies.

Keywords: HIV myopathy; Hematopoietic stem cell transplantation (HSCT); Monoclonal gammopathy; Nemaline myopathy; SLONM; Sporadic late-onset nemaline myopathy.

Publication types

  • Review

MeSH terms

  • Adult
  • Delayed Diagnosis
  • HIV Infections* / complications
  • Humans
  • Monoclonal Gammopathy of Undetermined Significance* / complications
  • Monoclonal Gammopathy of Undetermined Significance* / drug therapy
  • Monoclonal Gammopathy of Undetermined Significance* / pathology
  • Muscle, Skeletal
  • Myopathies, Nemaline* / diagnosis
  • Myopathies, Nemaline* / genetics
  • Myopathies, Nemaline* / therapy
  • Proteomics