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Hsu CY, Faisal Mutee A, Porras S, Pineda I, Ahmed Mustafa M, J Saadh M, Adil M, H A Z. Amphiregulin in infectious diseases: Role, mechanism, and potential therapeutic targets. Microb Pathog 2024; 186:106463. [PMID: 38036111 DOI: 10.1016/j.micpath.2023.106463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Abstract
Amphiregulin (AREG) serves as a ligand for the epidermal growth factor receptor (EGFR) and is involved in vital biological functions, including inflammatory responses, tissue regeneration, and immune system function. Upon interaction with the EGFR, AREG initiates a series of signaling cascades necessary for several physiological activities, such as metabolism, cell cycle regulation, and cellular proliferation. Recent findings have provided evidence for the substantial role of AREG in maintaining the equilibrium of homeostasis in damaged tissues and preserving epithelial cell structure in the context of viral infections affecting the lungs. The development of resistance to influenza virus infection depends on the presence of type 1 cytokine responses. Following the eradication of the pathogen, the lungs are subsequently colonized by several cell types that are linked with type 2 immune responses. These cells contribute to the process of repairing and resolving the tissue injury and inflammation caused by infections. Following influenza infection, the activation of AREG promotes the regeneration of bronchial epithelial cells, enhancing the tissue's structural integrity and increasing the survival rate of infected mice. In the same manner, mice afflicted with influenza experience rapid mortality due to a subsequent bacterial infection in the pulmonary region when both bacterial and viral infections manifest concurrently inside the same host. The involvement of AREG in bacterial infections has been demonstrated. The gene AREG experiences increased transcriptional activity inside host cells in response to bacterial infections caused by pathogens such as Escherichia coli and Neisseria gonorrhea. In addition, AREG has been extensively studied as a mitogenic stimulus in epithelial cell layers. Consequently, it is regarded as a prospective contender that might potentially contribute to the observed epithelial cell reactions in helminth infection. Consistent with this finding, mice that lack the AREG gene exhibit a delay in the eradication of the intestinal parasite Trichuris muris. The observed delay is associated with a reduction in the proliferation rate of colonic epithelial cells compared to the infected animals in the control group. The aforementioned findings indicate that AREG plays a pivotal role in facilitating the activation of defensive mechanisms inside the epithelial cells of the intestinal tissue. The precise cellular sources of AREG in this specific context have not yet been determined. However, it is evident that the increased proliferation of the epithelial cell layer in infected mice is reliant on CD4+ T cells. The significance of this finding lies in its demonstration of the crucial role played by the interaction between immunological and epithelial cells in regulating the AREG-EGFR pathway. Additional research is necessary to delve into the cellular origins and signaling mechanisms that govern the synthesis of AREG and its tissue-protective properties, independent of infection.
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Affiliation(s)
- Chou-Yi Hsu
- Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan City 71710, Taiwan
| | | | - Sandra Porras
- Facultad de Mecánica, Escuela Superior Politécnica de Chimborazo (ESPOCH), Panamericana Sur km 1 1/2, Riobamba, 060155, Ecuador
| | - Indira Pineda
- Facultad de Salud Pública, Escuela Superior Politécnica de Chimborazo (ESPOCH), Panamericana Sur km 1 1/2, Riobamba, 060155, Ecuador
| | - Mohammed Ahmed Mustafa
- Department of Medical Laboratory Technology, Imam Jaafar AL-Sadiq University, Iraq; Department of Pathological Analyzes, College of Applied Sciences, University of Samarra, Iraq.
| | - Mohamed J Saadh
- Faculty of Pharmacy, Middle East University, Amman, 11831, Jordan; Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | | | - Zainab H A
- Department of Pharmacy, Al-Zahrawi University College, Karbala, Iraq
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Matsuki Y, Sugihara T, Kihara T, Kawakami T, Kitaura T, Takata T, Nagahara T, Fujita K, Hirai M, Kato M, Kawaguchi K, Isomoto H. COVID-19-Triggered Acute Liver Failure and Rhabdomyolysis: A Case Report and Review of the Literature. Viruses 2023; 15:1445. [PMID: 37515132 PMCID: PMC10384858 DOI: 10.3390/v15071445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023] Open
Abstract
COVID-19 is primarily known for its respiratory tract involvement, often leading to severe pneumonia and exacerbation of underlying diseases. However, emerging evidence suggests that COVID-19 can result in multiorgan failure, affecting organs beyond the respiratory system. We present the case of a 62-year-old male with COVID-19 who developed acute liver failure (ALF) and rhabdomyolysis in the absence of respiratory failure. Initially, the patient presented with significantly elevated aspartate transaminase (5398 U/L) and alanine transaminase (2197 U/L) levels. Furthermore, a prolonged prothrombin time international normalized ratio (INR) of 2.33 indicated the diagnosis of ALF without hepatic coma, according to Japanese diagnostic criteria. The patient also exhibited elevated creatine kinase (9498 U/L) and a mild increase in creatinine (1.25 mg/dL) levels, but both values improved with intravenous fluid support and molnupiravir administration. To our knowledge, this is the first reported case presenting with both ALF and rhabdomyolysis associated with COVID-19. In addition, we review the existing literature to summarize previously reported cases of ALF triggered by SARS-CoV-2. This case report underscores the significance of recognizing COVID-19 as a significant contributing factor in the development of multiorgan failure. Furthermore, it suggests that COVID-19 can lead to severe illness, irrespective of the absence of respiratory failure.
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Affiliation(s)
- Yukako Matsuki
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Takaaki Sugihara
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Takuya Kihara
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Tatsuru Kawakami
- Division of Infectious Diseases, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Tsuyoshi Kitaura
- Division of Infectious Diseases, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Tomoaki Takata
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Takakazu Nagahara
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Kai Fujita
- Division of Medicine and Clinical Science, Department of Cardiovascular Medicine and Endocrinology and Metabolism, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Masayuki Hirai
- Division of Medicine and Clinical Science, Department of Cardiovascular Medicine and Endocrinology and Metabolism, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Masaru Kato
- Division of Medicine and Clinical Science, Department of Cardiovascular Medicine and Endocrinology and Metabolism, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Koichiro Kawaguchi
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Hajime Isomoto
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
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Impaired muscle stem cell function and abnormal myogenesis in acquired myopathies. Biosci Rep 2023; 43:232343. [PMID: 36538023 PMCID: PMC9829652 DOI: 10.1042/bsr20220284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/08/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Skeletal muscle possesses a high plasticity and a remarkable regenerative capacity that relies mainly on muscle stem cells (MuSCs). Molecular and cellular components of the MuSC niche, such as immune cells, play key roles to coordinate MuSC function and to orchestrate muscle regeneration. An abnormal infiltration of immune cells and/or imbalance of pro- and anti-inflammatory cytokines could lead to MuSC dysfunctions that could have long lasting effects on muscle function. Different genetic variants were shown to cause muscular dystrophies that intrinsically compromise MuSC function and/or disturb their microenvironment leading to impaired muscle regeneration that contributes to disease progression. Alternatively, many acquired myopathies caused by comorbidities (e.g., cardiopulmonary or kidney diseases), chronic inflammation/infection, or side effects of different drugs can also perturb MuSC function and their microenvironment. The goal of this review is to comprehensively summarize the current knowledge on acquired myopathies and their impact on MuSC function. We further describe potential therapeutic strategies to restore MuSC regenerative capacity.
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Suzuki I, Nakao R, Unai Y, Miyazaki Y. [A case of anti-SRP antibody-positive immune-mediated necrotizing myopathy triggered by human parvovirus B19 infection]. Rinsho Shinkeigaku 2022; 62:363-368. [PMID: 35474284 DOI: 10.5692/clinicalneurol.cn-001684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We have reported a case of a 44-year-old woman with anti-signal recognition particle (SRP) antibody-positive immune-mediated necrotizing myopathy triggered by human parvovirus B19 (PVB19) infection. She was admitted to the hospital because of lower leg edema and muscle weakness after erythema infectiosum. Magnetic resonance imaging of the lower extremities revealed high signals in the proximal muscles and subcutaneous edema on STIR. Muscle biopsy showed myofiber regenerative changes and variation in fiber size. A myositis-specific autoantibody profile indicated a positive result for anti-SRP antibodies. We diagnosed the patient with immune-mediated necrotizing myopathy (IMNM). Muscle strength and subcutaneous edema improved gradually in 3 months following immunotherapy. This is the first case report of an IMNM associated with PVB19 infection.
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Affiliation(s)
- Iku Suzuki
- Department of Neurology, Hyogo Prefectural Awaji Medical Center
| | - Ryohei Nakao
- Department of Neurology, Hyogo Prefectural Awaji Medical Center
| | - Yuki Unai
- Department of Neurology, Hyogo Prefectural Awaji Medical Center
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EKŞİOĞLU AS, AKCA ÇAĞLAR A, KAYNAK ŞAHAP S, KARACAN CD, TUYGUN N. Value of strain-wave sonoelastography as an imaging modality in assessment of benign acute myositis in children. Turk J Med Sci 2021; 51:2951-2958. [PMID: 34365785 PMCID: PMC10734879 DOI: 10.3906/sag-2103-290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 12/13/2021] [Accepted: 08/07/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim Although sonoelastography is applied in assessment of many organs, studies for evaluation of muscles are very few in number and are mostly limited to adults. With this prospective study, we aimed to evaluate the value of sonoelastography in assessment of influenza related benign acute myositis in children. Materials and methods This study enrolled 25 patients with a clinical diagnosis of benign acute childhood myositis (BACM) and 25 age and sex-matched healthy controls. All patients presented to our emergency department with the complaint of inability to walk and had increased serum creatine kinase (CK) levels. All patients underwent strain elastography of the gastrocnemius muscle, and an elastography score was assigned to each patient by using a previously published 5 point-color scoring system. The findings were compared with those of the control group. Results No statistically significant difference was detected regarding age, weight, height, or body mass index (BMI) between patient and control groups. A statistically significant difference was found between the final elastography scores of the patient and control groups, mean values being 4.16 ± 0.75 versus 3.08 ±0.40, respectively (p < 0.001). Sonoelastography yielded a sensitivity of 80%, positive predictive value of 87%, specificity 88%, negative predictive value of 81.5%, and an overall accuracy of 84 %. Conclusion Sonoelastography proves to be a valuable tool for diagnosis of BACM. It is one of the available ultrasound techniques in a radiology department and may particularly evolve to become a useful routine ancillary technique for investigation and follow-up in these cases.
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Affiliation(s)
- Ayşe Seçil EKŞİOĞLU
- Division of Pediatric Radiology, Department of Radiology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara,
Turkey
| | - Ayla AKCA ÇAĞLAR
- Division of Pediatric Emergency Care, Department of Pediatrics, Dr Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, University of Health Sciences, Ankara,
Turkey
| | - Seda KAYNAK ŞAHAP
- Division of Pediatric Radiology, Department of Radiology, Pediatric Radiology, Dr Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, University of Health Sciences, Ankara,
Turkey
| | - Can Demir KARACAN
- Division of Pediatric Emergency Care, Department of Pediatrics, Dr Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, University of Health Sciences, Ankara,
Turkey
| | - Nilden TUYGUN
- Division of Pediatric Emergency Care, Department of Pediatrics, Dr Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, University of Health Sciences, Ankara,
Turkey
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Hyczko AV, Rohrbaugh MK, Suliman AK, Hackman NM. A crawling case of benign acute childhood myositis. SAGE Open Med Case Rep 2021; 9:2050313X211047321. [PMID: 34552754 PMCID: PMC8450543 DOI: 10.1177/2050313x211047321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
Benign acute childhood myositis is a relatively uncommon complication of viral illness, particularly influenza A and B infections. In this abstract, we present a case report of benign acute childhood myositis secondary to influenza. On presentation, he was ill-appearing, febrile and had significant calf pain that limited mobility. Examination revealed mildly erythematous throat and bilateral calf tenderness with pain on dorsiflexion bilaterally. A respiratory virus panel was positive for influenza A subtype H3 and he was found to have an elevated creatine phosphokinase. He was diagnosed with benign acute childhood myositis secondary to influenza type A infection and symptoms gradually resolved following supportive management. Management involves oral hydration, pain management, and follow-up to ensure resolution. Extensive laboratory evaluation and hospitalization are often unnecessary. Benign acute childhood myositis is self-limiting with an excellent prognosis and should be included in the differential for a child who develops difficulty walking, particularly when presentation follows a respiratory infection.
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Bi L, Wei D, Wang B, He JF, Zhu HY, Wang HM. Trismus originating from rare fungal myositis in pterygoid muscles: A case report. World J Clin Cases 2021; 9:6872-6878. [PMID: 34447837 PMCID: PMC8362531 DOI: 10.12998/wjcc.v9.i23.6872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/20/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Trismus is a common problem with various causes. Any abnormal conditions of relevant anatomic structures that disturb the free movement of the jaw might provoke trismus. Trismus has a detrimental effect on the quality of life. The outcome of this abnormality is critically dependent on timely diagnosis and treatment, and it is difficult to identify the true origin in some cases. We present a rare case of trismus due to fungal myositis in the pterygoid muscle, excluding any other possible pathogenesis.
CASE SUMMARY The patient presented with a 2-mo history of restricted mouth opening. Computed tomography showed obvious enlargement of the left pterygoid muscles. Furthermore, the patient had trismus without obvious predisposing causes. The primary diagnosis was pterygoid myosarcoma. Consequently, lesionectomy of the left pterygoid muscle was performed. Intraoperative frozen biopsy implied the possibility of an uncommon infection. Postoperative pathologic examination confirmed myositis and necrosis in the pterygoid muscle. Fungi were detected in both muscle tissue and surrounding necrotic tissue. The patient recovered well with antifungal therapy and mouth opening exercises. The rarity of fungal myositis may be responsible for the misdiagnosis. Although the origin of pathogenic fungi is still unknown, we believe that both hematogenous spread and local invasion could be the most likely sources. To the best of our knowledge, this is the first case in the literature that reported fungal myositis in pterygoid muscles as the only reason that results in trismus.
CONCLUSION Surgeons should remain vigilant to the possibility of trismus originating from fungal myositis.
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Affiliation(s)
- Ling Bi
- Department of Stomatology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Dong Wei
- Department of Stomatology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Bo Wang
- Department of Pathology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Jian-Feng He
- Department of Stomatology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Hui-Yong Zhu
- Department of Stomatology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Hui-Ming Wang
- Department of Stomatology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou 310006, Zhejiang Province, China
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Javanian M, Barary M, Ghebrehewet S, Koppolu V, Vasigala V, Ebrahimpour S. A brief review of influenza virus infection. J Med Virol 2021; 93:4638-4646. [PMID: 33792930 DOI: 10.1002/jmv.26990] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 12/13/2022]
Abstract
Influenza is an acute viral respiratory infection that affects all age groups and is associated with high mortality during pandemics, epidemics, and sporadic outbreaks. Nearly 10% of the world's population is affected by influenza annually, with about half a million deaths each year. Influenza vaccination is the most effective method for preventing influenza infection and its complications. The influenza vaccine's efficacy varies each season based on the circulating influenza strains and vaccine uptake rates. Currently, three antiviral drugs targeting the influenza virus surface glycoprotein neuraminidase are available for treatment and prophylaxis of disease. Given the significant burden of influenza infection globally, this review is focused on the latest findings in the etiology, epidemiology, transmission, clinical manifestation, diagnosis, prevention, and treatment of influenza.
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Affiliation(s)
- Mostafa Javanian
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Barary
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Sam Ghebrehewet
- Cheshire and Merseyside Health Protection Team, Public Health England North West, Liverpool, UK
| | - Veerendra Koppolu
- Scientist, Department of Analytical Biotechnology, MedImmune/AstraZeneca, Gaithersburg, Maryland, 20878, USA
| | - VeneelaKrishnaRekha Vasigala
- Department of General Medicine, Rangaraya Medical College, NTR University of Health Sciences, Vijayawada, Andhra Pradesh, India
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Analysis of human total antibody repertoires in TIF1γ autoantibody positive dermatomyositis. Commun Biol 2021; 4:419. [PMID: 33772100 PMCID: PMC7997983 DOI: 10.1038/s42003-021-01932-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 02/03/2021] [Indexed: 12/17/2022] Open
Abstract
We investigate the accumulated microbial and autoantigen antibody repertoire in adult-onset dermatomyositis patients sero-positive for TIF1γ (TRIM33) autoantibodies. We use an untargeted high-throughput approach which combines immunoglobulin disease-specific epitope-enrichment and identification of microbial and human antigens. We observe antibodies recognizing a wider repertoire of microbial antigens in dermatomyositis. Antibodies recognizing viruses and Poxviridae family species are significantly enriched. The identified autoantibodies recognise a large portion of the human proteome, including interferon regulated proteins; these proteins cluster in specific biological processes. In addition to TRIM33, we identify autoantibodies against eleven further TRIM proteins, including TRIM21. Some of these TRIM proteins share epitope homology with specific viral species including poxviruses. Our data suggest antibody accumulation in dermatomyositis against an expanded diversity of microbial and human proteins and evidence of non-random targeting of specific signalling pathways. Our findings indicate that molecular mimicry and epitope spreading events may play a role in dermatomyositis pathogenesis. Megremis, Walker at al. identify immunogenic epitopes in dermatomyositis patients. They identify antibodies recognizing a wider diversity of microbial antigens including poxviruses, and autoantibodies recognizing a large portion of the human proteome. Shared epitope homology between viral and human proteins suggests that molecular mimicry and epitope spreading events may play a role in dermatomyositis pathogenesis.
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Buckholz AP, Kaplan A, Rosenblatt RE, Wan D. Clinical Characteristics, Diagnosis, and Outcomes of 6 Patients With COVID-19 Infection and Rhabdomyolysis. Mayo Clin Proc 2020; 95:2557-2559. [PMID: 33153641 PMCID: PMC7831467 DOI: 10.1016/j.mayocp.2020.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/10/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Adam P Buckholz
- NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY
| | - Alyson Kaplan
- NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY
| | | | - David Wan
- NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY
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Abstract
Purpose of review The purpose of this paper is to comprehensively evaluate secondary causes of inflammatory myopathies (myositis) and to review treatment options. Recent findings This review highlights recent advancements in our understanding of known causes of myositis, including newer drugs that may cause myositis such as checkpoint inhibitors and viruses such as influenza, HIV, and SARS-CoV2. We also discuss treatment for malignancy-associated myositis and overlap myositis, thought to be a separate entity from other rheumatologic diseases. Summary Infections, drugs, rheumatologic diseases, and malignancies are important causes of myositis and are important to diagnose as they may have specific therapies beyond immunomodulatory therapy.
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Affiliation(s)
- Sarah H Berth
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Thomas E Lloyd
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
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12
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Gan WK. Rare case of extensive streptococcal myositis. BMJ Case Rep 2020; 13:13/8/e235400. [PMID: 32847881 DOI: 10.1136/bcr-2020-235400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A rare case of extensive streptococcal myositis is reported. A 46-year-old man was admitted following acute swollen right elbow joint associated with localised pain, erythema and hypoaesthesia. Multiple tense blisters subsequently developed around the affected elbow joint extending to the axilla. He was treated for suspected soft tissue infection and septic arthritis. Blood test investigations demonstrated raised creatine kinase (894 U/L) and inflammatory markers (white cell count 21.1×109/L; C reactive protein 370 mg/L). Emergency CT scan reported extensive myositis affecting the triceps, latissimus dorsi and pectoralis major muscle with no fascial involvement. He was escalated to intensive care unit and treated for infectious myositis. Further investigation revealed positive streptococcal antibody (anti-streptodornase B titre >1600 U/mL). He was managed conservatively with microbiologist specialist input and supportive care. The patient made good recovery after receiving 10 days of intravenous antibiotics and subsequently switched to oral antibiotics. He was discharged on day 30 of admission after receiving intensive inpatient physiotherapy.
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Affiliation(s)
- Weh Kiat Gan
- Dermatology, Salford Royal NHS Foundation Trust, Salford, UK
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Verdiner RE, Choukalas CG, Siddiqui S, Stahl DL, Galvagno SM, Jabaley CS, Bartz RR, Lane-Fall M, Goff K, Sreedharan R, Bennett S, Williams GW, Khanna A. COVID-Activated Emergency Scaling of Anesthesiology Responsibilities Intensive Care Unit. Anesth Analg 2020; 131:365-377. [PMID: 32398432 PMCID: PMC7219847 DOI: 10.1213/ane.0000000000004957] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2020] [Indexed: 02/06/2023]
Abstract
In response to the rapidly evolving coronavirus disease 2019 (COVID-19) pandemic and the potential need for physicians to provide critical care services, the American Society of Anesthesiologists (ASA) has collaborated with the Society of Critical Care Anesthesiologists (SOCCA), the Society of Critical Care Medicine (SCCM), and the Anesthesia Patient Safety Foundation (APSF) to develop the COVID-Activated Emergency Scaling of Anesthesiology Responsibilities (CAESAR) Intensive Care Unit (ICU) workgroup. CAESAR-ICU is designed and written for the practicing general anesthesiologist and should serve as a primer to enable an anesthesiologist to provide limited bedside critical care services.
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Affiliation(s)
| | | | - Shahla Siddiqui
- Department of Anesthesiology, Pain, and Intensive Care, Beth Israel Deaconess Medical Center, Harvard Medical School
| | | | - Samuel M. Galvagno
- Multi Trauma Critical Care Unit, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine
| | | | - Raquel R. Bartz
- Departments of Anesthesia and Medicine, Duke University School of Medicine
| | - Meghan Lane-Fall
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania
| | - Kristina Goff
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center
| | - Roshni Sreedharan
- Center for Excellence in Healthcare Communication, Anesthesiology Institute, Cleveland Clinic
| | - Suzanne Bennett
- Department of Anesthesiology, University of Cincinnati College of Medicine
| | - George W. Williams
- Department of Anesthesiology, UT Health McGovern Medical School at Houston
| | - Ashish Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine
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Scaber J, Molyneux AJ, Buckley C, Webb AJS. Two case reports of distal upper limb weakness following influenza-like illness: an emerging pattern of para-infectious myositis in adults. BMC Neurol 2020; 20:237. [PMID: 32522188 PMCID: PMC7285489 DOI: 10.1186/s12883-020-01821-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background Myositis is a recognised complication of numerous systemic viral infections including influenza. In adults the typical pattern is characterised by myalgia and marked proximal muscle weakness in upper and lower limbs and resolves slowly over weeks rather than days. Case presentation Here, we describe two male patients with myositis with an unusual distribution of weakness in the distal upper limbs, which both followed a flu-like illness and resolved spontaneously. Both patients had moderate elevations in creatine kinase, extensive negative serological investigations, normal nerve conduction studies and myopathic changes on electromyography. Conclusions In the para-infectious context, myositis is an important differential of acute distal upper limb weakness. This unusual pattern of acute muscle weakness should be recognised to avoid unnecessary in treatments. Similar cases in the recent literature in male patients between the ages of 25 to 55 are reviewed and suggest an emerging pattern of para-infectious myositis.
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Affiliation(s)
- Jakub Scaber
- Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing Level 6, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Adam J Molyneux
- Department of Clinical Neurophysiology, Oxford University Hospitals, Foundation Trust, Oxford, UK
| | - Camilla Buckley
- Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing Level 6, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Alastair J S Webb
- Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing Level 6, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.
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Lentscher AJ, McCarthy MK, May NA, Davenport BJ, Montgomery SA, Raghunathan K, McAllister N, Silva LA, Morrison TE, Dermody TS. Chikungunya virus replication in skeletal muscle cells is required for disease development. J Clin Invest 2020; 130:1466-1478. [PMID: 31794434 PMCID: PMC7269570 DOI: 10.1172/jci129893] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 11/26/2019] [Indexed: 02/06/2023] Open
Abstract
Chikungunya virus (CHIKV) is an arbovirus capable of causing a severe and often debilitating rheumatic syndrome in humans. CHIKV replicates in a wide variety of cell types in mammals, which has made attributing pathologic outcomes to replication at specific sites difficult. To assess the contribution of CHIKV replication in skeletal muscle cells to pathogenesis, we engineered a CHIKV strain exhibiting restricted replication in these cells via incorporation of target sequences for skeletal muscle cell-specific miR-206. This virus, which we term SKE, displayed diminished replication in skeletal muscle cells in a mouse model of CHIKV disease. Mice infected with SKE developed less severe disease signs, including diminished swelling in the inoculated foot and less necrosis and inflammation in the interosseous muscles. SKE infection was associated with diminished infiltration of T cells into the interosseous muscle as well as decreased production of Il1b, Il6, Ip10, and Tnfa transcripts. Importantly, blockade of the IL-6 receptor led to diminished swelling of a control CHIKV strain capable of replication in skeletal muscle, reducing swelling to levels observed in mice infected with SKE. These data implicate replication in skeletal muscle cells and release of IL-6 as important mediators of CHIKV disease.
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Affiliation(s)
- Anthony J. Lentscher
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Center for Microbial Pathogenesis, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary K. McCarthy
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicholas A. May
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Bennett J. Davenport
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Stephanie A. Montgomery
- Department of Pathology and Laboratory Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Krishnan Raghunathan
- Center for Microbial Pathogenesis, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Nicole McAllister
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Center for Microbial Pathogenesis, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Laurie A. Silva
- Center for Microbial Pathogenesis, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Thomas E. Morrison
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Terence S. Dermody
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Center for Microbial Pathogenesis, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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16
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Molina B, Pogossian A, De Moreuil C, Rouvière B, Le Berre R. [Infectious myositis]. Rev Med Interne 2020; 41:241-249. [PMID: 32113637 DOI: 10.1016/j.revmed.2020.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 01/21/2020] [Accepted: 02/01/2020] [Indexed: 01/08/2023]
Abstract
Infectious myositis is a rare condition that can be caused by bacteria, viruses, parasites or fungi. Muscle pain or weakness are symptoms shared by all type of myositis. Diagnosis is made on clinical presentation: fever and poor general state is found in bacterial myositis, diffuse muscle pain with flu-like symptoms in viral causes, eosinophilia and a tropical travel history can be related to parasitic etiology, and immunocompromising condition suggests fungal infection. Rhabdomyolysis, leukocytosis and elevated C-reactive protein are common. Imaging (computed tomography or magnetic resonance imaging) can be useful to detect which muscle is affected. The causative organism can be identified on blood cultures, skeletal muscle biopsy, serology or any other pathogen specific test. Treatment depends on the causative organism. Open surgical or imaging-guided drainage is usually necessary in bacterial myositis.
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Affiliation(s)
- B Molina
- Service de médecine interne, vasculaire et pneumologie, hôpital de la Cavale Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France
| | - A Pogossian
- Service de médecine interne, vasculaire et pneumologie, hôpital de la Cavale Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France
| | - C De Moreuil
- Service de médecine interne, vasculaire et pneumologie, hôpital de la Cavale Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; EA 3878, GETBO, université de Brest, Brest, France
| | - B Rouvière
- Service de médecine interne, vasculaire et pneumologie, hôpital de la Cavale Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; UMR 1227 « Lymphocytes B et auto-immunité », université de Brest, Brest, France
| | - R Le Berre
- Service de médecine interne, vasculaire et pneumologie, hôpital de la Cavale Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; Inserm, UMR 1078, université de Brest, Brest, France.
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17
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Thammaroj P, Panitchote A, Muktabhant C, Chowchuen P. Discrimination between tuberculous and bacterial pyomyositis in magnetic resonance features. Eur J Radiol Open 2020; 7:100214. [PMID: 33102635 PMCID: PMC7569411 DOI: 10.1016/j.ejro.2020.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 01/31/2023] Open
Abstract
Discriminating imaging features between bacterial and tuberculous pyomyositis. T2 high signal intensity at abscess wall can predict for bacterial pyomyositis. Abscess wall character on imaging of bacterial muscle infection. Magnetic resonance imaging between bacterial and tuberculous muscle infection.
Purpose The purpose of this study was to assess the differences of magnetic resonance features between tuberculous and bacterial pyomyositis. Method This is a retrospective study of patients with bacterial and tuberculous pyomyositis. We excluded patients with pyomyositis caused by actinomycosis, non-tuberculous mycobacterium, fungi, unknown of causative organism, or inadequate imaging for analysis. Magnetic resonance imaging was independently reviewed by two radiologists. Results Of the 136 pyomyositis patients, 71 (52.2 %) patients had bacterial pyomyositis while 65 (47.8 %) patients had tuberculous pyomyositis. Seventy-seven patients (56.6 %) had intramuscular abscess. On multivariable analysis, bacterial pyomyositis was associated with diabetes mellitus (odds ratio [OR] 3.17, 95 % confidence interval [CI] 1.30–8.24) and bone marrow involvement (OR 5.02, 95 % CI 1.21–34.4). Spinal involvement had a significantly lower likelihood of bacterial pyomyositis (OR 0.25, 95 %CI 0.11–0.54). In patients with intramuscular abscess, diabetes mellitus and hyperintense on T2-weighted images at the abscess wall had a significantly higher likelihood of bacterial pyomyositis (OR 5.21, 95 %CI 1.33–25.42 and OR 5.34, 95 %CI 1.36–24.71, respectively), whereas spinal involvement had a significantly lower likelihood of bacterial pyomyositis (OR 0.09, 95 %CI 0.02–0.30). Conclusions Magnetic resonance imaging has modest accuracy for differentiation of tuberculous and bacterial pyomyositis. Diabetes mellitus and extraspinal pyomyositis were the predictors of bacterial pyomyositis. Presence of T2 hyperintense wall of intramuscular abscess was also the predictor of bacterial pyomyositis.
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Affiliation(s)
- Punthip Thammaroj
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Anupol Panitchote
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Chawiporn Muktabhant
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Prathana Chowchuen
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
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18
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Imataki O, Uemura M, Masugata H. Severe rhabdomyolysis associated with severe fever with thrombocytopenia syndrome in a married couple: a case report. BMC Infect Dis 2019; 19:885. [PMID: 31651242 PMCID: PMC6813050 DOI: 10.1186/s12879-019-4535-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne infection that has recently emerged. This infectious disease is due to the transfer of SFTS virus (SFTSV) from the infected blood of animals to humans. Approximately 30% of patients who are infected with SFTS die from multiorgan failure associated with severe infection, systemic inflammatory response syndrome, or disseminated intravascular coagulation. We treated an elderly Japanese couple (husband and wife) who had genetically identical SFTSV infections and who both developed severe rhabdomyolysis. Case presentation An 80-year-old man presented to the clinic with a fever; his 74-year-old wife presented with a fever 9 days later. Their laboratory results at diagnosis showed severe rhabdomyolysis with significantly elevated creatinine kinase (detected levels: husband, 9546 U/L; wife, 15,933 U/L). The creatinine kinase isozyme was 100% MM type in both patients. In both the husband and wife, SFTSV was identified with real-time polymerase chain reaction analysis. The detected SFTSVs in both the husband and wife were identical according to the genome sequence analysis. The husband’s bone marrow indicated macrophage activation syndrome, but he responded to supportive therapy. He was discharged after being hospitalized for 32 days. The wife was admitted to our hospital in critical condition 2 days after SFTS symptom onset. She died of multiorgan failure 8 days after onset, despite being cared for in an intensive care unit. Both of the patients presented with rhabdomyolysis following SFTS symptom onset. The patients’ clinical outcomes were different from each other; i.e., the husband survived, and the wife died. Conclusions SFTSV infection-associated rhabdomyolysis has been reported in one patient, and simultaneous onset in two related patients has not been described previously. Our findings suggest that similar biological responses occurred, but they resulted in different clinical outcomes in the patients infected by the identical SFTSV isolates. Notably, a patient’s clinical outcome depends on their own immune response. We suggest that one component of viral rhabdomyolysis involves immune-mediated responses. Severe immunological responses may adversely affect the treatment outcome, as demonstrated by the wife’s clinical course. Our findings demonstrate that a patient’s immune response contributes to their prognosis following SFTSV infection.
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Affiliation(s)
- Osamu Imataki
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-town, Kita-county, Kagawa, 761-0793, Japan.
| | - Makiko Uemura
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-town, Kita-county, Kagawa, 761-0793, Japan
| | - Hisashi Masugata
- Department of Integrated Medicine, Faculty of Medicine, Kagawa University, Miki, Kagawa, Japan
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19
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Myositis Mimics—a Clinical Approach to a Diagnostic Challenge. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2018. [DOI: 10.1007/s40674-018-0108-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Jin RM, Warunek J, Wohlfert EA. Therapeutic administration of IL-10 and amphiregulin alleviates chronic skeletal muscle inflammation and damage induced by infection. Immunohorizons 2018; 2:142-154. [PMID: 30417170 PMCID: PMC6223302 DOI: 10.4049/immunohorizons.1800024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Maintenance of tissue integrity in skeletal muscle requires the immunomodulatory and regenerative functions of muscle-resident regulatory T cells (Tregs). Chronic skeletal muscle infections, such as with Toxoplasma gondii disrupt normal immuno-regulatory networks and lead to pathogenic changes in Treg function. Specifically, Tregs during chronic T. gondii infection reinforce an inflammatory macrophage bias that exacerbates injury in skeletal muscle. In this study, we investigated whether the aberrations in skeletal muscle Treg function during chronic infection could be overcome by treatment with Treg-related factors associated with enhanced muscle regeneration during sterile injury. We show treatment of chronically infected mice with the Treg promoting therapies, interleukin-2 complexed with anti-IL-2 antibody or interleukin-33 (IL-33), did not restore macrophage dynamics or muscle function, respectively, in vivo. However supplementation of known Treg-derived factors, interleukin-10 (IL-10) and amphiregulin (Areg) improved muscle function and skewed macrophages toward a restorative phenotype in the presence of chronic infection. These shifts in macrophage phenotype are coupled with enhanced physiologic parameters of regeneration. Together, these data suggest that while Treg-mediated immuno-regulation is compromised during chronic skeletal muscle infection, supplementation of canonical Treg-derived factors such as IL-10 and Areg can restore immunologic balance and enhance muscle repair.
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Affiliation(s)
- Richard M Jin
- * Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Jordan Warunek
- * Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Elizabeth A. Wohlfert
- * Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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21
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Paul SP, Fillon G, Heaton PA. Benign acute childhood myositis secondary to parainfluenza A virus. Br J Hosp Med (Lond) 2017; 78:410-411. [DOI: 10.12968/hmed.2017.78.7.410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Siba P Paul
- Honorary Consultant Paediatrician, Department of Paediatrics, Yeovil District Hospital, Higher Kingston, Yeovil
| | - Gabriela Fillon
- Consultant Paediatrician, Department of Paediatrics, Yeovil District Hospital, Higher Kingston, Yeovil
| | - Paul A Heaton
- Consultant Paediatrician, Department of Paediatrics, Yeovil District Hospital, Higher Kingston, Yeovil
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22
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Devic P, Gallay L, Streichenberger N, Petiot P. Focal myositis: A review. Neuromuscul Disord 2016; 26:725-733. [PMID: 27726926 DOI: 10.1016/j.nmd.2016.08.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 12/27/2022]
Abstract
Amongst the heterogeneous group of inflammatory myopathies, focal myositis stands as a rare and benign dysimmune disease. Although it can be associated with root and/or nerve lesions, traumatic muscle lesions and autoimmune diseases, its triggering factors remain poorly understood. Defined as an isolated inflammatory pseudotumour usually restricted to one skeletal muscle, clinical presentation of focal myositis is that of a rapidly growing solitary mass within a single muscle, usually in the lower limbs. Electromyography shows spontaneous activity associated with a myopathic pattern. MRI reveals a contrast enhanced enlarged muscle appearing hyper-intense on FAT-SAT T2 weighted images. Adjacent structures are spared and there are no calcifications. Serum creatine kinase (CK) levels are usually moderately augmented and biological markers of systemic inflammation are absent in most cases. Pathological histological features include marked variation in fibre size, inflammatory infiltrates mostly composed of T CD4+ lymphocytes and macrophages, degenerating/regenerating fibres and interstitial fibrosis. Differential diagnoses are numerous and include myositis of other origin with focal onset. Steroid treatment should be reserved for patients who present with major pain, nerve lesions, associated autoimmune disease, or elevated C reactive protein or CK.
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Affiliation(s)
- P Devic
- Department of Functional Neurology and Epileptology, Pierre Wertheimer Neurology University Hospital, 69 Bdv Pinel, 69677 Bron-Cedex, France; University Claude Bernard Lyon-I, France.
| | - L Gallay
- University Claude Bernard Lyon-I, France; Department of Clinical Immunology, Pavillon O, Edouard Herriot University Hospital, 5 place d'Arsonval, 69437 Lyon Cedex 03, France; NeuroMyoGen Institute, CNRS UMR 5310 - INSERM U1217, France
| | - N Streichenberger
- University Claude Bernard Lyon-I, France; NeuroMyoGen Institute, CNRS UMR 5310 - INSERM U1217, France; Department of Pathology, Lyon East University Hospital, 69 Bdv Pinel, 69677 Bron-Cedex, France
| | - P Petiot
- Department of Neurology, Croix-Rousse University Hospital, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
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23
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Koehler AV, Spratt DM, Norton R, Warren S, McEwan B, Urkude R, Murthy S, Robertson T, McCallum N, Parsonson F, Bradbury RS, Gasser RB. More parasitic myositis cases in humans in Australia, and the definition of genetic markers for the causative agents as a basis for molecular diagnosis. INFECTION GENETICS AND EVOLUTION 2016; 44:69-75. [PMID: 27312103 DOI: 10.1016/j.meegid.2016.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 11/18/2022]
Abstract
Since 1998, there have been six reported human cases of myositis in Australia, attributable to infection with the nematode Haycocknema perplexum. However, an unequivocal diagnosis of H. perplexum infection and associated disease has been seriously compromised by a lack of molecular markers for this nematode. Here, we report new cases of disseminated myositis in two male patients from the states of Queensland and Tasmania in Australia, respectively; genetically characterize the causative agent from each case; and, also establish a PCR-based sequencing approach as a tool to support the diagnosis of future cases and to underpin epidemiological studies.
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Affiliation(s)
- Anson V Koehler
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Victoria, Australia
| | - David M Spratt
- Australian National Wildlife Collection, Commonwealth Scientific and Industrial Research Organisation, Canberra, Australia
| | - Robert Norton
- Pathology Queensland, Townsville Hospital, Queensland, Australia
| | - Sanchia Warren
- Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Tasmania, Australia
| | - Belinda McEwan
- Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Tasmania, Australia
| | - Ravindra Urkude
- Department of Neurology, The Townsville Hospital, Queensland, Australia
| | - Suresh Murthy
- Department of Neurology, The Townsville Hospital, Queensland, Australia
| | - Thomas Robertson
- Anatomical Pathology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia; Department of Molecular and Cellular Pathology, School of Medicine, University of Queensland, Queensland 4006, Australia
| | - Naomi McCallum
- Electron Microscope Unit, Pathology Queensland, Royal Brisbane & Women's Hospital, Queensland, Australia
| | - Fiona Parsonson
- Pathology Queensland, Townsville Hospital, Queensland, Australia
| | - Richard S Bradbury
- School of Medical and Applied Sciences, Central Queensland University, Rockhampton, North Rockhampton, Queensland, Australia.
| | - Robin B Gasser
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Victoria, Australia.
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McGuinness SL, Leder K. Global Burden of Toxocariasis: A Common Neglected Infection of Poverty. CURRENT TROPICAL MEDICINE REPORTS 2014. [DOI: 10.1007/s40475-013-0012-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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25
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Kulkarni H, Lenzo N, McLean-Tooke A. Causality of rhabdomyolysis and combined tetanus, diphtheria and acellular pertussis (Tdap) vaccine administration. J Clin Pharmacol 2013; 53:1099-102. [PMID: 23913623 DOI: 10.1002/jcph.145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 06/30/2013] [Indexed: 01/30/2023]
Affiliation(s)
- Hemant Kulkarni
- Department of Nephrology and Transplantation, Fremantle Hospital, Fremantle, Western Australia, Australia
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26
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Okada H, Wada M, Sato H, Yamaguchi Y, Tanji H, Kurokawa K, Kawanami T, Takahashi T, Kato T. Neuromyelitis optica preceded by hyperCKemia and a possible association with coxsackie virus group A10 infection. Intern Med 2013; 52:2665-8. [PMID: 24292760 DOI: 10.2169/internalmedicine.52.1042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report the case of a 48-year-old woman presenting with an elevated serum creatine kinase level (hyperCKemia) associated with an initial attack of neuromyelitis optica (NMO). The patient initially showed general fatigue with fever. Laboratory findings showed hyperCKemia and subsequently she developed a slight weakness of both lower limbs and reduced vision. Autoantibodies against aquaporin 4 were found in her serum, and a retrospective examination of viral titers indicated a possible coxsackie virus group A10 infection. The present case suggests that hyperCKemia-mediated disease onset is involved in some patients with NMO, and furthermore, it may be related to muscular destruction associated with viral infection.
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Affiliation(s)
- Hiroaki Okada
- Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology, Yamagata University Faculty of Medicine, Japan
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27
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Parasitic infections and myositis. Parasitol Res 2011; 110:1-18. [PMID: 21881948 DOI: 10.1007/s00436-011-2609-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 08/04/2011] [Indexed: 12/20/2022]
Abstract
Infectious myositis may be caused by a wide variety of bacterial, fungal, viral, and parasitic agents. Parasitic myositis is most commonly a result of trichinosis, cystericercosis, or toxoplasmosis, but other parasites may be involved. A parasitic cause of myositis is suggested by history of residence or travel to endemic area and presence of eosinophilia. The diagnosis of parasitic myositis is suggested by the clinical picture and radiologic imaging, and the etiologic agent is confirmed by parasitologic, serologic, and molecular methods, together with histopathologic examination of tissue biopsies. Therapy is based on the clinical presentation and the underlying pathogen. Drug resistance should be put into consideration in different geographic areas, and it can be avoided through the proper use of anti-parasitic drugs.
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