cN1A Antibody-Positive Inclusion Body Myositis Following Seminoma Manifesting With Slowly Progressive Paraparesis: A Case Report

A case of inclusion body myositis (IBM) with autoantibodies against cN1A following orchiectomy for seminoma has not been previously described. A 60-year-old man developed slowly progressive, painless paraparesis of the lower extremities and mild hyper-creatine kinase (CK)emia three years after orchiectomy for a unilateral seminoma. Clinical examination 10 years after onset revealed weakness of hip flexion (Medical Research Council (MRC) 5-), knee flexion (MRC 5-), and foot extension (left MRC 4-, right MRC 5-); absent tendon reflexes; and thigh muscle atrophy. Needle electromyography was normal, but contrast-enhanced muscle MRI indicated myositis. Quadriceps muscle biopsy revealed terminally remodeled muscle tissue with fibrosis and adipose tissue replacement, as well as a few residual, markedly atrophic, myopathic muscle fibers and COX-negative fibers suggestive of IBM, primary myopathy, or a neurogenic lesion with secondary myopathy. Myositis antibody testing showed a marked increase in cN1A. In summary, this case demonstrates that cN1A antibody-associated IBM can occur following seminoma, IBM can begin with proximally accentuated paraparesis of the lower extremities, the correct diagnosis can take years, and muscle MRI, biopsy, and antibody testing, but not electromyography, can be diagnostically helpful.