Multicore disease

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Abstract
A 46-year-old white man had a 12-year history of progressive, symmetrical proximal weakness. Changes consistent with a myopathy were seen on electromyography, along with normal nerve conduction velocities. Serum creatine phosphokinase was slightly elevated. Muscle biopsies showed type I fiber predominance and focal areas of absent or increased oxidative enzyme activity, with other fibers containing focal areas of absent myofibril-lar ATPase activity. Serial sections showed little correlation between abnormalities demonstrated with oxidative enzymes and ATPase. Ultrastruc-tural changes included focal disruption of myofibrils and Z-band streaming. Similar morphologic changles have previously been described in a congenital, nonprogressive myopathy.

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