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Galluzzo C, Chiapparoli I, Corrado A, Cantatore FP, Salvarani C, Pipitone N. Rare forms of inflammatory myopathies - part II, localized forms. Expert Rev Clin Immunol 2023; 19:185-191. [PMID: 36469645 DOI: 10.1080/1744666x.2023.2154655] [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: 12/12/2022]
Abstract
INTRODUCTION The idiopathic inflammatory myopathies traditionally comprise dermatomyositis, polymyositis, the anti-synthetase syndromes, immune-mediated necrotizing myopathy and inclusion body myositis. However, there are uncommon localized forms that are less known. In this review, we aimed to cover these uncommon forms. AREAS COVERED We identified rare forms of localized myositis on the basis of list provided by the homepage of the Neuromuscular disease center of Washington University, USA and on the basis of the authors' knowledge. We searched PubMed® for relevant articles on these forms with the aim of providing as much as possible information on their clinical manifestations as well as guidance on their work-up and treatment. EXPERT OPINION herein, we provide un updated description of rare forms of localized myositis. These forms are often difficult to diagnose because of their localized nature and are sometimes misdiagnosed as tumors. Knowledge about these rare forms of localized myositis can aid in their recognition and treatment.
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Affiliation(s)
- Claudio Galluzzo
- Department of Internal Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Chiapparoli
- Department of Internal Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ada Corrado
- Department of Medical and Surgical Sciences, Rheumatology Clinic, University of Foggia, Foggia, Italy
| | - Francesco Paolo Cantatore
- Department of Medical and Surgical Sciences, Rheumatology Clinic, University of Foggia, Foggia, Italy
| | - Carlo Salvarani
- Department of Internal Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Internal Medicine, Università di Modena e Reggio Emilia, Modena, Italy
| | - Nicolò Pipitone
- Department of Internal Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Focal myositis: a rare case report. Turk J Phys Med Rehabil 2017; 63:181-184. [PMID: 31453449 DOI: 10.5606/tftrd.2017.78466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 05/20/2015] [Indexed: 11/21/2022] Open
Abstract
Focal myositis is an uncommon, self-limiting, benign skeletal muscle disease, which is generally determined as an inflammatory pseudotumor. The etiology is not fully known, although it has been suggested that subclinical damage may play a role. As it leads to a tumoral mass it may be confused with several diseases leading to incorrect evaluations. Definitive diagnosis is made by biopsy of the skeletal muscle. In radiologic diagnosis, magnetic resonance imaging is the most important modality. In this paper we presented the imaging findings of a 58-year-old female patient with focal myositis who was admitted with complaints of forearm swelling.
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Abstract
This report describes a rare case of recurrent bilateral focal myositis and its successful treatment via methotrexate. A 38-year-old man presented myalgia of the right gastrocnemius in May 2005. Magnetic resonance imaging showed very high signal intensity in the right gastrocnemius on short-tau inversion recovery images. A muscle biopsy revealed inflammatory CD4+ cell-dominant myogenic change. Focal myositis was diagnosed. The first steroid treatment was effective. Tapering of prednisolone, however, repeatedly induced myositis relapse, which progressed to multiple muscle lesions of both lower limbs. Initiation of methotrexate finally allowed successful tapering of prednisolone, with no relapse in the past 4 years.
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Affiliation(s)
- Hiroko Nagafuchi
- Division of Rheumatology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
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Perlepe V, Dallaudière B, Omoumi P, Hristova L, Rezzazadeh A, Vande Berg B, Malghem J, Lecouvet F. Self-resolving focal non-ossifying myositis: a poorly known clinical and imaging entity diagnosed with MRI. Acta Radiol Open 2015; 4:2058460115606156. [PMID: 26668755 PMCID: PMC4668995 DOI: 10.1177/2058460115606156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 07/27/2015] [Accepted: 08/13/2015] [Indexed: 11/15/2022] Open
Abstract
Background Focal myositis is a rare benign inflammatory pseudotumor, presenting as a painful nodular mass within a muscle, and characterized by spontaneous resolution within weeks. Purpose To assess the clinical and imaging findings of focal nodular myositis simulating a neoplasm at clinical examination, with no history of trauma. Material and Methods This study describes the locations and appearance at ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) of this condition in a series of five patients. Results MRI and US displayed a solid intramuscular “tumor” and suggested a continuum between the proximal and distal muscle fibers that appeared thickened within the nodular lesion, a sign that has been reported in myositis ossificans. MRI showed edema in adjacent muscles and soft tissues, as well as intense enhancement of the mass. Intense vascular flows were seen at Doppler analysis. CT did not reveal the appearance of peripheral ossifications, ruling out the diagnosis of myositis ossificans. In some patients, the diagnosis of sarcoma had been suggested as possible by the radiologist. Imaging follow-up with MRI showed complete resolution of the masses over several weeks, thus avoiding a biopsy; no recurrence was observed at long-term follow-up (more than 24 months). Conclusion This paper highlights MRI and US findings in focal non-ossifying myositis, and emphasizes the role of MRI in suggesting this diagnosis, leading to the careful follow-up of the lesion until its resolution, and ruling out more aggressive lesions.
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Affiliation(s)
- Vasiliki Perlepe
- Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Benjamin Dallaudière
- Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Patrick Omoumi
- Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Lora Hristova
- Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Afshin Rezzazadeh
- Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Bruno Vande Berg
- Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Jacques Malghem
- Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Frederic Lecouvet
- Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium
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Focal myositis: a clinicopathologic study of 115 cases of an intramuscular mass-like reactive process. Am J Surg Pathol 2010; 33:1016-24. [PMID: 19363438 DOI: 10.1097/pas.0b013e31819e63fe] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Focal myositis is an uncommon inflammatory pseudotumor of skeletal muscle that can be confused with a variety of neoplastic and inflammatory diseases. It is often misunderstood because it presents as a tumor-like mass, but histologically resembles a skeletal muscle myopathy or dystrophy. We wanted to discuss the detailed morphologic and immunophenotypic features of the largest reported group of focal myositis patients. DESIGN Two hundred and six cases coded as "focal myositis" were culled from our files. Only 115 cases with adequate material, a solitary lesion, and correct diagnosis were included. A variety of immunohistochemical studies were performed, as were polymerase chain reaction for T cell receptor gene rearrangement and immunoglobulin heavy chain rearrangement. RESULTS Age ranged from 7 to 94 years (mean 41, median 36 y). Most patients were otherwise healthy, and with the exception of 10 cases, lacked antecedent trauma. Masses that ranged in size from 1.0 to 20.0 cm (median 3.0 cm, mean 3.9 cm) were reported in specific muscles of the lower extremities (including vastus lateralis, adductor muscle, and groin muscles, n=39; gastrocnemius, n=22), followed by the trunk, neck (mentalis, n=8; sternocleidomastoid muscle, n=8), and upper extremity. Histologically, these were solitary intramuscular processes composed of variable myopathic (93%) and focal neurogenic (89%) changes, fibrosis, and inflammation (97%), occasionally accompanied by prominent eosinophils (n=20). By immunohistochemistry, most cases had CD163-positive macrophages that were negative for S100 protein and CD1a. Lymphocytes were mostly CD3, CD4-positive lymphocytes that were negative for cytotoxic markers, TIA-1 and granzyme-B. Polymerase chain reaction did not show B cell or T cell rearrangement. In situ studies for Epstein-Barr-encoded receptor were negative, as was ALK-1 immunohistochemistry. Major histocompatibility complex-1 and weak IgG4 were focally positive in skeletal muscle. Cases with severe inflammation had increased numbers of CD20-positive B cells and CD123-positive plasmacytic dendritic cells. S100 was strongest in skeletal muscle fibers with vacuolar change. Clinical diagnostic considerations ranged from benign entities such as rhabdomyoma, intramuscular lipoma, fibromatosis, myositis ossificans, proliferative myositis, inflammatory myofibroblastic tumor, and inflammatory myopathy to malignant entities such as rhabdomyosarcoma, leiomyosarcoma, liposarcoma, and lymphoma. Available follow-up revealed spontaneous regression. CONCLUSIONS Focal myositis occurs in specific muscle groups of young adults of both sexes without significant trauma. It is a largely unrecognized entity with specific histology including myopathic, focal neurogenic, fibrosis, and inflammatory features. It can be easily mistaken for an inflammatory myopathy, dystrophy, alternate reactive, or even neoplastic process. Focal myositis seems to be a macrophage and T-cell-rich lesion that changes to B cell and dendritic plasmacytoid cells when markedly inflamed, but does not seem to have a known viral or molecular etiology. IgG4 presence may be linked to the fibrosis in these lesions; a possible transient autoimmune etiology cannot be excluded. Careful attention to reproducible clinicopathologic features can aid diagnosis and spare patients from excessive surgery or adverse therapy.
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Melzer N, Wessig C, Ulzheimer J, Reiners K, Toyka K, Bendszus M, Stoll G. Distal-symmetric focal inflammatory myopathy distinct from focal myositis and polymyositis. Muscle Nerve 2009; 40:309-12. [DOI: 10.1002/mus.21316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Gaeta M, Mazziotti S, Minutoli F, Genitori A, Toscano A, Rodolico C, Blandino A. MR imaging findings of focal myositis: a pseudotumour that may mimic muscle neoplasm. Skeletal Radiol 2009; 38:571-8. [PMID: 19255757 DOI: 10.1007/s00256-009-0664-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2008] [Revised: 01/07/2009] [Accepted: 02/10/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The authors describe magnetic resonance (MR) findings in eight patients with histologically confirmed focal myositis. MATERIALS AND METHODS In each patient, axial TSE T1-weighted and fast short-tau inversion recovery (STIR) images were obtained using a 1.5-T MR scanner. Three patients also underwent dynamic contrast-enhanced MR examination using a GE T1-weighted sequence. The following features were evaluated: anatomical distribution, extent of the involvement, signal intensity characteristics, dynamic enhancement pattern and outcome at follow-up examinations. RESULTS Seven of eight lesions were located in the lower extremities, one of eight in the arm; four of eight involved part of a muscle, two of eight diffusely involved a muscle and two of eight showed multifocal involvement of two or more muscles. All lesions were hyperintense on fast-STIR images: the hyperintensity was homogeneous in six of eight and inhomogeneous in two of eight. On T1-weighted unenhanced images, all lesions but two appeared isointense or slightly hypointense in comparison to normal muscles; two lesions showed a slight hyperintensity. Dynamic enhancement pattern corresponded to the type usually seen in benign soft tissue lesions. All lesions disappeared. CONCLUSION Focal myositis is an uncommon pseudotumour which should be considered in the differential diagnosis of muscular masses and myopathies.
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Affiliation(s)
- Michele Gaeta
- Department of Radiological Sciences, University of Messina, AOU Policlinico G Martino, Messina, Italy
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Gono T, Katsumata Y, Kawaguchi Y, Soejima M, Wakasugi D, Miyawaki M, Tsukahara S, Yamanaka H, Hara M. Selective expression of MHC class I in the affected muscle of a patient with idiopathic inflammatory myopathy. Clin Rheumatol 2009; 28:873-6. [PMID: 19322621 DOI: 10.1007/s10067-009-1172-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 03/18/2009] [Indexed: 11/24/2022]
Abstract
The dominant clinical feature of polymyositis/dermatomyositis is weakness in proximal, rather than distal, musculature. Although rare, cases of focal/localized myositis in which polymyositis-like muscle inflammation is present in only one muscle or extremity have also been reported. The underlying mechanisms dictating involvement of specific muscle groups in polymyositis/dermatomyositis and focal/localized myositis have not been identified. Here, we describe a rare case of dropped-head syndrome due to localized idiopathic inflammatory myopathy (IIM) in the splenius capitis (neck extensor) muscle where major histocompatibility complex (MHC) class I expression was up-regulated in involved muscle fibers. Interestingly, the adjacent trapezius muscle was not affected, corresponding to muscle biopsy findings that did not show any sign of inflammation or MHC class I expression. Our case report therefore suggests that selection of affected muscle in IIM might be influenced by the MHC class I expression of the muscle.
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Affiliation(s)
- T Gono
- Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
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Hewer E, Goebel HH. Myopathology of non-infectious inflammatory myopathies – The current status. Pathol Res Pract 2008; 204:609-23. [DOI: 10.1016/j.prp.2008.03.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2007] [Revised: 02/24/2008] [Accepted: 03/04/2008] [Indexed: 11/29/2022]
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Gross R, Degive C, Dernis E, Plat M, Dubourg O, Puéchal X. Focal Myositis of the Calf following S1 Radiculopathy. Semin Arthritis Rheum 2008; 38:20-7. [DOI: 10.1016/j.semarthrit.2007.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Revised: 09/04/2007] [Accepted: 09/23/2007] [Indexed: 10/22/2022]
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Froissart A, Pagnoux C, Koskas F, Dubourg O, Chérin P. Les malformations vasculaires à développement intramusculaire : un diagnostic différentiel rare de myosite focale. Rev Med Interne 2006; 27:50-3. [PMID: 16236388 DOI: 10.1016/j.revmed.2005.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2005] [Accepted: 08/09/2005] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Focal myositis constitutes an original and rare pathological entity, characterized by a localized inflammation within skeletal muscle, presenting as a soft tissue painful tumefaction. Diagnosis requires histological confirmation because of its non-specific clinical feature and the numerous differential diagnoses. EXEGESIS We report a 27 year-old man who presented with suggestive symptoms of focal myositis. MR imaging and echography were compatible with this diagnosis but also demonstrated the existence of a vascular component within the tumefaction. The diagnosis of a benign vascular malformation with intramuscular development was made by a surgically guided biopsy. CONCLUSION Vascular malformations are histologically heterogeneous with extremely variable clinical expressions. When they develop within skeletal muscle, they may mimic focal myositis. Hence, their diagnosis has to be evoked before performing muscle biopsy, because of the potential hemorrhagic risk.
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Affiliation(s)
- A Froissart
- Service de médecine interne I, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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Rodolico C, Mazzeo A, Toscano A, Messina S, Aguennouz M, Gaeta M, Messina C, Vita G. Specific matrix metalloproteinase expression in focal myositis: an immunopathological study. Acta Neurol Scand 2005; 112:173-7. [PMID: 16097959 DOI: 10.1111/j.1600-0404.2005.00457.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of our study was to investigate immunoexpression of matrix metalloproteinases MMP2, MMP7 and MMP9 in muscle specimens from patients with focal myositis (FM) vs polymyositis (PM) and dermatomyositis. MATERIALS AND METHODS We studied muscle biopsy samples from seven patients affected by FM; samples from five patients each with PM and dermatomyositis were studied as disease controls. RESULTS MMP2 immunoreactivity was present in PM and dermatomyositis, MMP7 only in PM, and MMP9 in PM, dermatomyositis and FM. CONCLUSIONS Our results confirm that increased MMP9 immunoreactivity in muscle fibres is a common feature of all inflammatory myopathies and suggest that MMP2 and MMP7 cannot be implicated in the inflammatory events of FM.
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Affiliation(s)
- C Rodolico
- Department of Neurosciences, Psychiatry and Anaesthesiology, University of Messina, Messina, Italy.
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Abstract
Most neuromuscular disorders display only non-specific myopathological features in routine histological preparations. However, a number of proteins, including sarcolemmal, sarcomeric, and nuclear proteins as well as enzymes with defects responsible for neuromuscular disorders, have been identified during the past two decades, allowing a more specific and firm diagnosis of muscle diseases. Identification of protein defects relies predominantly on immunohistochemical preparations and on Western blot analysis. While immunohistochemistry is very useful in identifying abnormal expression of primary protein abnormalities in recessive conditions, it is less helpful in detecting primary defects in dominantly inherited disorders. Abnormal immunohistochemical expression patterns can be confirmed by Western blot analysis which may also be informative in dominant disorders, although its role has yet to be established. Besides identification of specific protein defects, immunohistochemistry is also helpful in the differentiation of inflammatory myopathies by subtyping cellular infiltrates and demonstrating up-regulation of subtle immunological parameters such as cell adhesion molecules. The role of immunohistochemistry in denervating disorders, however, remains controversial in the absence of a reliable marker of muscle fibre denervation. Nevertheless, as well as the diagnostic value of immunocytochemical analysis it may also widen understanding of muscle fibre pathology as well as help in the development of therapeutic strategies.
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Affiliation(s)
- D S Tews
- Edinger-Institute of the Johann-Wolfgang Goethe-University, Frankfurt, Germany.
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Uppal SS, Salopal TK, Singh H. Left gluteal focal myositis in a patient with signet ring adenocarcinoma of the stomach: not a paraneoplastic phenomenon. Rheumatol Int 2004; 24:365-7. [PMID: 14968264 DOI: 10.1007/s00296-003-0437-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2003] [Accepted: 12/13/2003] [Indexed: 11/30/2022]
Abstract
Focal myositis, the much rarer clinical and pathological variant of polymyositis, is generally a benign inflammatory pseudotumor of skeletal muscle Thus far, only three cases have been reported in association with a neoplasm. We now describe a fourth case of localized gluteal myositis seen in a case of signet ring adenocarcinoma of the stomach occurring not as a paraneoplastic syndrome, as in the previously reported three cases, but as an immunoinflammatory response around metastatic cell foci in both the involved muscles and local lymphatics.
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Affiliation(s)
- S S Uppal
- Department of Medicine, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait.
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Streichenberger N, Meyronet D, Fiere V, Pellissier JF, Petiot P. Focal myositis associated with S-1 radiculopathy: Report of two cases. Muscle Nerve 2004; 29:443-6. [PMID: 14981746 DOI: 10.1002/mus.10540] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Two cases are described of pseudotumoral calf hypertrophy after laminectomy for a compressive S-1 radiculopathy. The serum creatine kinase (CK) level was normal or mildly elevated. T2-weighted magnetic resonance imaging (MRI) showed calf enlargement, with an increased signal of the medial head of the gastrocnemius muscle. Electromyography revealed fibrillation potentials and positive sharp waves, but no complex repetitive discharges in the affected gastrocnemius muscle, with motor unit potentials having mixed neurogenic and myopathic features. Muscle biopsy revealed a focal myositis associated with some features of denervation. A brief course of corticosteroids was followed by remission clinically and improvement in the MRI findings.
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Pachman LM. Juvenile dermatomyositis: immunogenetics, pathophysiology, and disease expression. Rheum Dis Clin North Am 2002; 28:579-602, vii. [PMID: 12380371 DOI: 10.1016/s0889-857x(02)00013-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Data are rapidly accumulating documenting disease susceptibility may be linked to genetic markers (DQA1*0501 or related alleles) which are associated with upregulation of IFN-alpha/beta inducible genes elicited in response to an antigen which may be viral. Continued immune-mediated inflammation, resulting in partial lipodystrophy and pathological calcifications, may be fanned by the increased production of TNF alpha usually associated with the TNF alpha-308A allele.
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Affiliation(s)
- Lauren M Pachman
- Division of Immunology/Rheumatology, Department of Pediatrics, Children's Memorial Institute for Education and Research, Feinberg School of Medicine, Northwestern University, 2300 Children's Plaza, Box #50, Chicago, IL 60614, USA.
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Erdem S, Demirci M, Tan E. Focal myopathy mimicking posterior interosseous nerve syndrome. Muscle Nerve 2001; 24:969-72. [PMID: 11410927 DOI: 10.1002/mus.1097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 25-year-old man developed weakness of extension of the right index, middle, and fourth fingers at the metacarpophalangeal joints, over 2 years. No sensory deficit was present. Nerve conduction studies, including the right radial nerve, were within normal limits. Needle electromyographic (EMG) examination showed myopathic changes that were limited to the right extensor digitorum communis and extensor indicis proprius muscles. An intravenous edrophonium chloride test had no effect on weakness and repetitive stimulation showed no significant decremental response. An EMG-guided open biopsy of the extensor digitorum communis muscle revealed severe myopathic changes. Evaluation for the cause of myopathic involvement was negative. After 13 months, clinical examination and electrophysiological studies showed no significant progression. This case exemplifies the fact that a focal myopathy may mimic an entrapment neuropathy.
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Affiliation(s)
- S Erdem
- Hacettepe University Faculty of Medicine, Department of Neurology, Ankara 06100, Turkey.
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18
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Abstract
To clarify the nosology of focal myositis (FM), we report the clinical and pathologic features of eight patients presenting with focal enlargement of one muscle. Most patients improved without immunosuppressive therapy, and none developed polymyositis. Pathologic features were those of an inflammatory myopathy, with muscle fiber hypertrophy and moderate to severe inflammation. In most cases, a clustering of tightly packed muscle fibers, enveloped by a thick bundle of fibrosis, was associated with the diagnosis of FM. Immunohistochemistry showed T cell predominance within the interstitial infiltrates in all cases. No evidence of vasculitis was present. Our findings suggest that FM is a benign condition that has certain clinical features separating it from other inflammatory myopathies. Pathologic changes, such as large clusters of nesting muscle fibers surrounded by thick fibrosis, are more characteristic of FM than polymyositis.
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Affiliation(s)
- A G Smith
- Department of Neurology, University of Utah Medical Center, Salt Lake City, Utah, USA
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19
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Abstract
This review article describes the imaging finding of the connective tissue disorders in children. The radiological features of the following conditions are described; the spondyloarthropathics, systemic lupus erythematosus (SLE), dermatomyositis, scleroderma, the vasculitides, Kawasaki disease, synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO), and focal myositis. The features on several integrated imaging techniques are described.
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Affiliation(s)
- R Hanlon
- Royal Liverpool Children's NHS Trust, UK
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20
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Abstract
Focal myositis is a rare inflammatory pseudotumor of skeletal muscle which usually has a benign course. We report a 56-year-old woman with a painful mass in the left arm with a radial nerve palsy. Magnetic resonance imaging (MRI) of the left arm showed a mass in the triceps muscle that was suggestive of a soft-tissue sarcoma. Electromyography showed a severe radial neuropathy involving both motor and sensory axons. An open biopsy showed focal myositis. Treatment with corticosteroids resulted in complete disappearance of the mass clinically and by MRI, without recurrence for more than 2 years. Radial nerve function also recovered completely. As a treatable cause of focal neuropathy, focal myositis should be included in the differential diagnosis of a muscle mass.
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Affiliation(s)
- B I Alzagatiti
- Department of Neurology, University of Tennessee Memphis, and Methodist Hospitals of Memphis, 855 Monroe Avenue, Room 415, Memphis, Tennessee 38163, USA
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Kocanaogullari H, Ozdemir E, Keser G, Tuncbay T, Gumusdis G, Doganavsargil E. Focal myositis. Clin Rheumatol 1998; 17:65-7. [PMID: 9586683 DOI: 10.1007/bf01450962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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23
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Toti P, Romano L, Villanova M, Zazzi M, Luzi P. Focal myositis: a polymerase chain reaction analysis for a viral etiology. Hum Pathol 1997; 28:111-3. [PMID: 9013843 DOI: 10.1016/s0046-8177(97)90290-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Focal myositis (FM) is a benign inflammatory condition that may clinically simulate a soft tissue sarcoma. It was first described in 1977, and only approximately 30 cases have been reported to date, yet this entity is probably more frequent. The pathogenesis of FM is totally unknown. It has been proposed that it represents a nodular form of myositis, which can evolve into polymyositis, but this hypothesis has not been confirmed by follow-up studies. We describe seven cases of FM, five of which have never been reported before. Histology of the lesions was very similar, showing a destructive inflammatory myopathy with evidence of regeneration. Our study attempted to better understand the pathogenesis of this focal inflammatory myopathy. We performed a polymerase chain reaction study to explore the presence of a number of viral infectious agents in the inflammed tissue. The present study failed to show the presence of a known viral agent with a recognized tropism for myofibers. With a panel of lymphoid cell markers, we also characterized the phenotype of the inflammatory infiltrate that was composed of many T-lymphocytes with few CD4+ cells. Lastly, we reviewed the published cases and discuss the possible pathogenesis.
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Affiliation(s)
- P Toti
- Department of Pathology, University of Siena, Italy
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Moreno-Lugris C, Gonzalez-Gay MA, Sanchez-Andrade A, Blanco R, Basanta D, Ibanez D, Pulpeiro JR. Magnetic resonance imaging: a useful technique in the diagnosis and follow up of focal myositis. Ann Rheum Dis 1996; 55:856. [PMID: 8976647 PMCID: PMC1010326 DOI: 10.1136/ard.55.11.856] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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