ELN and multiminicore myopathy: Even though the pathogenesis of MMD remains unclear, there are prominent pathological features noted; proliferation and migration of smooth muscle cells in the intima, leading to intimal thickening with morphological and biochemical alteration of extracellular matrix components such as elastin, collagen and proteoglycans[2, 19] without signs of any inflammation or atheromatous plaque.[1, 20] Junichi et al,[21] found MMD to have a bimodal peak of distribution with the first peak at 10 years and the second in the fourth decade.