Abstract
To the Editor:— Lang et al in their interesting report Vacuolar Myopathy in Lupus Erythematosus ( JAMA 191 :49 [Jan 4] 1965) neglected to mention a second possible cause for the myopathy noted in their patient with systemic lupus erythematosus. This patient had been receiving chloroquine phosphate in apparently continuous dosage for approximately four years prior to the onset of her weakness. Whisnant et al in Chloroquine Neuromyopathy ( Proc Mayo Clin 38 :501 [Nov 6] 1963) reported four cases and mentioned three others with a very similar picture of generalized muscle weakness, with accentuation of weakness in the proximal muscle groups developing in those patients who had taken chloroquine for extended periods. Neck flexor weakness was observed and the muscle-stretch reflexes were weak to absent in the extremities. There were no sensory abnormalities. The serum glutamic oxaloacetic transaminase was elevated in their case 1. The histological changes in skeletal muscle in
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