Weak at the knees

Clinical case

A 24-year-old man of Nigerian heritage presented to the emergency department with a 1-day history of acute, ascending limb weakness. This had begun in both feet and ascended to the thighs, predominantly affecting the knees. He had a 1-day history of palpitation and a 2-day prodromal history of myalgia, cramps and stiffness involving the proximal lower limbs. There had been no recent trauma or infective symptoms, and no recent period of intense exercise, strenuous activity, heavy alcohol consumption or history of myoglobinuria. He studied from home and had been sedentary for most days before admission. There was no relevant family history. He was under the care of the mental health team for a previous episode of psychosis 6 years before, for which he was prescribed aripiprazole but had been non-compliant.

On examination, he was alert and very anxious, but with no respiratory distress and not requiring oxygen therapy. His…

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