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On light microscopy early changes include degenerating necrotic muscle fibers with invasion by macrophages, as well as clusters of small- to intermediate-sized regenerating muscle fibers which have basophilic cytoplasm. [2] Increased variability of muscle fiber size is also seen, initially with larger than normal, then smaller than normal fibers as the disease progresses. [76] Type 1 fiber predominance is observed, as are hypercontracted muscle fibers. Eventually there is significant replacement of muscle fibers by fat and endomysial connective tissue [ Figure 2 ].

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