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To the Editor:
Di Giovanni et al.1 present interesting evidence that apoptosis mediated by proteolytic proteases could play an essential role in acute quadriplegic myopathy (AQM). However, the features of the muscle biopsies that they described for their three patients are remarkable in some ways. Usually, in the biopsy specimens of patients with AQM there is a more or less selective atrophy of type II myofibers,2 sometimes associated with myofiber vacuolization.3 Interestingly, Di Giovanni et al.1 did not observe this morphologic feature in their three patients. In addition, a selective loss of myosin filaments is not necessarily seen on ultrastructural examination, because either loss of all filaments4,5 …
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