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Jiang S, Li J, Cao J, Ou Y, Duan Y, Gan X. Clinical Characteristics of 118 Pediatric Patients With Acute Benign Myositis Associated With Influenza A Virus Infection. Pediatr Infect Dis J 2024; 43:626-629. [PMID: 38535510 DOI: 10.1097/inf.0000000000004320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
OBJECTIVE The objective of this study was to investigate the clinical and laboratory features of acute benign myositis associated with influenza A virus infection in children. METHODS A retrospective analysis was performed on the clinical data of 118 children with acute benign myositis associated with influenza A virus infection who were admitted to the Children's Hospital of Chongqing Medical University during the epidemic period of influenza A from February 2023 to May 2023. RESULTS (1) Most of the 118 children were preschool- or school-age. The most common symptom was sudden lower limb pain after fever, and bilateral calf myalgia was more common. The muscle enzyme spectrum ranged from 187.21 to 32191.00 μg/L (median: 3053 μg/L). Creatine kinase isoenzymes ranged from 5.15 to 749.7 μg/L (median 41.82 μg/L). Myoglobin ranged from 102.79 to 1200 μg/L (median 674.9 μg/L). (3) Examination: electromyography, muscle color Doppler ultrasound, radiograph and cardiac color Doppler ultrasound in Benign acute childhood myositis in children were rarely positive. (4) Treatment and prognosis: besides bed rest and a reduction of physical activity, oseltamivir treatment, drugs to improve energy metabolism, fluid replacement and alkalinization of symptomatic treatment. All children had a good prognosis without sequelae. CONCLUSIONS This study summarized and analyzed the clinical characteristics of acute benign myositis associated with influenza A infection in children with the aim of allowing rapid and early diagnosis of the disease and reducing unnecessary diagnostic tests and treatments. Closely monitoring myalgia and the muscle enzyme spectrum is recommended to exclude other neuromuscular and metabolic diseases.
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Affiliation(s)
- Shaoqun Jiang
- From the Department of Medical General Ward, Children's Hospital of Chongqing Medical University, Chongqing, China
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Pal D, Roy SG, Singh R, Hayeri MR. Imaging features of soft-tissue infections. Skeletal Radiol 2024:10.1007/s00256-024-04694-4. [PMID: 38702530 DOI: 10.1007/s00256-024-04694-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 04/07/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
Skin and soft tissues are among the most common sites of infections. Infections can involve the superficial epidermis to deep muscles and bones. Most infections spread through contiguous structures, although hematogenous spread can occur in the setting of an immunocompromised state and with atypical infections. While clinical diagnosis of infections is possible, it often lacks specificity, necessitating the use of imaging for confirmation. Cross-sectional imaging with US, CT, and MRI is frequently performed not just for diagnosis, but to delineate the extent of infection and to aid in management. Nonetheless, the imaging features have considerable overlap, and as such, it is essential to integrate imaging features with clinical features for managing soft tissue infections. Radiologists must be aware of the imaging features of different infections and their mimics, as well as the pros and cons of each imaging technique to properly use them for appropriate clinical situations. In this review, we summarize the most recent evidence-based features of key soft tissue infections.
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Affiliation(s)
- Devpriyo Pal
- North Bengal Medical College, Siliguri, West Bengal, India
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3
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Albar RF, Hubayni RA, Aldahhas RA, Khshwry EI. Viral Myositis Secondary to Influenza A in a Preschool Child in Saudi Arabia: A Case Report. Cureus 2024; 16:e53179. [PMID: 38420103 PMCID: PMC10901551 DOI: 10.7759/cureus.53179] [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] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Infective myositis is a rare complication of viral infection, occurring most commonly in children. Here, we present the first case report in Saudi Arabia that describes a four-year-old healthy female who presented to the emergency department with a history of fever associated with coryzal symptoms for four days and a one-day history of bilateral lower limb pain and an inability to walk without assistance. Lower limb pain was not associated with joint pain, swelling, or skin rashes. The respiratory virus panel was positive for influenza A, and she was found to have increased levels of creatine kinase (CK). The patient was diagnosed with viral myositis secondary to influenza type A infection and was admitted for dehydration. She was treated successfully with supportive measures and oseltamivir. The patient's condition improved three days after the initial presentation and was discharged and followed up to ensure resolution. Extensive laboratory assessment and hospitalization can often be deemed unnecessary, given that the majority of cases of viral myositis carry a positive prognosis and are self-limiting. Therefore, it is important to consider viral myositis as a potential diagnosis for a child presenting with difficulties walking, particularly if these symptoms arise following a respiratory infection.
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Affiliation(s)
- Rawia F Albar
- Pediatrics, King Abdulaziz Medical City, Ministry of National Gaurd, Jeddah, SAU
| | - Rahaf A Hubayni
- Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Raghad A Aldahhas
- Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Elaf I Khshwry
- Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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4
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Tuchinsky A, Montalvo A, Lent D, Goldman J. Acute myositis secondary to Epstein-Barr virus in the absence of infectious mononucleosis with severe rhabdomyolysis. BMJ Case Rep 2023; 16:e256313. [PMID: 38103909 PMCID: PMC10728920 DOI: 10.1136/bcr-2023-256313] [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] [Indexed: 12/19/2023] Open
Abstract
SummaryRhabdomyolysis is characterised by muscle breakdown which causes myoglobin light chain release and can result in renal injury. While some of the most common causes of rhabdomyolysis are trauma related, others include toxins, autoimmune processes or viral aetiologies. We present the case of a 20s-year-old man, with no significant medical history, who presented to the emergency department with a 1-week history of weakness, myalgias, nausea, vomiting and subjective fevers. A review of systems and physical exam were otherwise unremarkable, including being negative for sore throat, dysphagia and lymphadenopathy. On presentation, the patient was noted to have dark urine with a creatine kinase value of 452 458 U/L and an elevated creatinine at 7.23 mg/dL. The patient denied any trauma or increased physical activity. His toxin screen and autoimmune workup were negative. The patient's serological workup was significant for acute Epstein-Barr virus (EBV) infection, without additional viral coinfection or mononucleosis. During his hospitalisation course, the patient was managed with supportive care including haemodialysis. The patient made a full renal recovery and was discharged with scheduled outpatient follow-up. This case highlights the recognition of an acute EBV infection causing rhabdomyolysis in the absence of mononucleosis or concomitant infection.
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Affiliation(s)
- Adam Tuchinsky
- Internal Medicine, UPMC-Lititz, Lititz, Pennsylvania, USA
| | | | - Dale Lent
- Internal Medicine, UPMC-Lititz, Lititz, Pennsylvania, USA
| | - John Goldman
- Division of Infectious Disease, UPMC-Harrisburg, Harrisburg, Pennsylvania, USA
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5
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Patil P, Davidson J, Patel S. An undifferentiated cause of rhabdomyolysis: a case report. Int J Emerg Med 2023; 16:35. [PMID: 37170192 PMCID: PMC10173214 DOI: 10.1186/s12245-023-00507-y] [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: 02/28/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Rhabdomyolysis can occur secondary to infections, trauma, or myotoxic substances. Rhabdomyolysis secondary to autoimmune myositis occurs rarely. Distinguishing autoimmune rhabdomyolysis from rhabdomyolysis secondary to other causes is paramount in considering the long-term management of autoimmune rhabdomyolysis. It is further important to continue close follow-up and further testing to completely understand the extent of this disease as diagnoses may be ever-changing. CASE PRESENTATION A previously healthy female presented to the hospital with myalgias and myoglobinuria following a respiratory infection treated with azithromycin and promethazine. Labs demonstrating elevated creatine kinase (CK) prompted treatment for rhabdomyolysis and rheumatology consultation. The patient was given 3 l of intravenous (IV) 0.9% sodium chloride in the Emergency Department. Upon admission, the patient was placed on a continuous IV drip of 0.9% sodium chloride running at 300 cc/hour for all 8 days of her hospital admission. The rheumatology autoantibody panel pointed towards autoimmune myositis as a potential cause of her rhabdomyolysis. The patient was discharged to follow up with rheumatology for further testing. CONCLUSION Autoimmune myositis, although less common than other etiologies of rhabdomyolysis, is important to consider as the long-term management of autoimmune myositis includes the use of immunosuppressants, antimalarials, or IV immunoglobulins, which may be inappropriate for other etiologies of rhabdomyolysis.
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Affiliation(s)
- Pallavi Patil
- Cooper Medical School of Rowan University, Camden, NJ, USA.
| | | | - Sundip Patel
- Department of Emergency Medicine, Cooper University Hospital, Camden, NJ, USA
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6
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Caffarelli C, Santamaria F, Piro E, Basilicata S, Delle Cave V, Cipullo M, Bernasconi S, Corsello G. New insights in pediatrics in 2021: choices in allergy and immunology, critical care, endocrinology, gastroenterology, genetics, haematology, infectious diseases, neonatology, neurology, nutrition, palliative care, respiratory tract illnesses and telemedicine. Ital J Pediatr 2022; 48:189. [PMID: 36435791 PMCID: PMC9701393 DOI: 10.1186/s13052-022-01374-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/25/2022] [Indexed: 11/28/2022] Open
Abstract
In this review, we report the developments across pediatric subspecialties that have been published in the Italian Journal of Pediatrics in 2021. We highlight advances in allergy and immunology, critical care, endocrinology, gastroenterology, genetics, hematology, infectious diseases, neonatology, neurology, nutrition, palliative care, respiratory tract illnesses and telemedicine.
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Affiliation(s)
- Carlo Caffarelli
- Department of Medicine and Surgery, Clinica Pediatrica, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci 14, Parma, Italy.
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Ettore Piro
- Department of Sciences for Health Promotion and Mother and Child Care G. D'Alessandro, University of Palermo, Palermo, Italy
| | - Simona Basilicata
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Valeria Delle Cave
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Marilena Cipullo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care G. D'Alessandro, University of Palermo, Palermo, Italy
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7
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Herndon CM, Nguyen V. Patterns of Viral Arthropathy and Myalgia Following COVID-19: A Cross-Sectional National Survey. J Pain Res 2022; 15:3069-3077. [PMID: 36199500 PMCID: PMC9528961 DOI: 10.2147/jpr.s373295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Viral arthropathy is an increasingly recognized sequela of several viral pathogens including alphaviruses, hepatitis, and potentially coronaviruses. Case reports of viral arthropathy and myalgia associated with SARS-CoV-2 infection (COVID-19) both during active disease and following resolution of acute COVID-19 symptoms are becoming more prevalent. We sought to describe the prevalence of viral arthropathy and myalgia associated with COVID-19, as well as to identify factors that may predict these symptoms. Methods A national, cross-sectional survey was conducted using a questionnaire administered online. Subjects self-reporting previous confirmed COVID-19 were recruited using the Amazon Mechanical Turk crowdsourcing platform. Questionnaire items included demographics, frequency and severity of common COVID-19 symptoms, requirement for hospitalization or mechanical ventilation, subject recall of arthropathy or myalgia onset, duration, and severity, as well as WOMAC score. Binary logistic regression was used to identify potential predictive co-variates for the development of either arthropathy or myalgia. Results A total of 3222 participants completed the arthropathy/myalgia questionnaire with 1065 responses remaining for analysis following application of exclusion criteria, data integrity review, and omission of respondents with confounding conditions. Of the 1065 cases, 282 (26.5%) reported arthralgia and 566 (53.2%) reported myalgia at some point during or after COVID-19 with 9.9% and 6.0% reporting onset of arthralgia or myalgia, respectively, after resolution of acute COVID-19 symptoms. The presence of several commonly reported COVID symptoms or indicators of disease severity was predictive of arthralgia including hospitalization (OR 3.7; 95% CI 2.4 to 5.8), sore throat (OR 2.3; 95% CI 1.5 to 3.5), fatigue (OR 2.9; 95% CI 1.7 to 4.9), and ageusia/anosmia (OR 1.7; 95% CI 1.1 to 2.7). Discussion Based on these results, new-onset arthropathy and myalgia following COVID-19 resolution may be an increasingly encountered etiology for pain.
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Affiliation(s)
- Christopher M Herndon
- School of Pharmacy, Southern Illinois University Edwardsville, Edwardsville, IL, 62026, USA
- Correspondence: Christopher M Herndon, School of Pharmacy, Southern Illinois University Edwardsville, 200 University Park Drive, Box 2000, Edwardsville, IL, 62026, USA, Tel +1 618.650.5116, Email
| | - Van Nguyen
- Hospital Sisters Health System, O’Fallon, IL, 62269, USA
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Akıncı Göktaş Ö, Bektaş Ö, Öz Tunçer G, Birsin Özçakar Z, Talim B, Tuba Eminoğlu F, Teber S. A Rare Pediatric Case of Severe Rhabdomyolysis Owing to Dual Infection. KLINISCHE PADIATRIE 2022; 234:119-122. [PMID: 35255503 DOI: 10.1055/a-1486-7186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM We aimed to report a severe and rare pediatric rhabdomyolysis case associated with a dual viral infection. CASE A 13 year-old, healthy girl presented with the complaints of fever, abdominal pain, weakness and dark-colored urine. She was diagnosed with rhabdomyolysis based on clinical signs and laboratory findings. The diagnosis was confirmed by serological tests and real-time polymerase chain reaction for Epstein-Barr virus (EBV) and cytomegalovirus (CMV), respectively. Other potential genetic, metabolic and infectious causes were evaluated meticulously but no evidence was found. This case is also important as it is the first reported case to our knowledge on rhabdomyolysis associated with EBV and CMV co-infection in children. CONCLUSION The presented case experienced tetraplegia due to the severe muscular damage and muscle power returned to normal range after 3 months. This suggests that EBV and CMV may have exert synergistic effects leading to more severe inflammation and degeneration.
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Affiliation(s)
- Özben Akıncı Göktaş
- Department of child neurology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ömer Bektaş
- Department of child neurology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gökçen Öz Tunçer
- Department of child neurology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Birsin Özçakar
- Department of child nephrology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Beril Talim
- Department of pediatric pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fatma Tuba Eminoğlu
- Department of Pediatric Metabolic Disseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Serap Teber
- Department of child neurology, Ankara University Faculty of Medicine, Ankara, Turkey
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Chetram VK, Ahmad AI, Farid S, Sood T. Acute Kidney Injury Secondary to Rhabdomyolysis and COVID-19: A Case Report and Literature Review. Case Rep Nephrol 2021; 2021:5528461. [PMID: 34367704 PMCID: PMC8337150 DOI: 10.1155/2021/5528461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/26/2021] [Indexed: 02/06/2023] Open
Abstract
The viral infection causing COVID-19 most notably affects the respiratory system but can result in extrapulmonary clinical manifestations as well. Rhabdomyolysis-associated acute kidney injury (AKI) in the setting of COVID-19 is an uncommon complication of the infection. There is significant interest in this viral infection given its global spread, ease of transmission, and varied clinical manifestations and outcomes. This case report and literature review describes the symptoms, laboratory findings, and clinical course of a patient who developed AKI secondary to rhabdomyolysis and COVID-19, which will help clinicians recognize and treat this condition.
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Affiliation(s)
- Vishaka K. Chetram
- Department of Internal Medicine, Washington Hospital Center, Washington, DC 20010, USA
| | - Akram I. Ahmad
- Department of Internal Medicine, Washington Hospital Center, Washington, DC 20010, USA
| | - Saira Farid
- Department of Internal Medicine, Washington Hospital Center, Washington, DC 20010, USA
| | - Tanuj Sood
- Department of Internal Medicine, Washington Hospital Center, Washington, DC 20010, USA
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10
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Kietaibl AT, Fangmeyer-Binder M, Göndör G, Säemann M, Fasching P. Acute viral myositis: profound rhabdomyolysis without acute kidney injury. Wien Klin Wochenschr 2021; 133:847-850. [PMID: 33905028 PMCID: PMC8076669 DOI: 10.1007/s00508-021-01866-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/25/2021] [Indexed: 01/04/2023]
Abstract
Background Acute viral myositis (AVM) may be triggered by influenza A/B, enteroviruses and other viruses. Severe complications including rhabdomyolysis regularly lead to acute kidney injury (AKI). The aim of this short report was to discuss management and differential diagnosis of massive creatine kinase (CK) elevation. Patient, material and methods Herein, we report on a 19-year-old Austrian male of African descent with a history of respiratory tract infections and whole-body pain. He further developed acute viral myositis and massive CK elevation up to 440,000 IU/L but without any signs of AKI. A literature search relating AVM, management and differential diagnosis of rhabdomyolysis was conducted in PubMed and UptoDate. Results A full panel of serological and autoimmune blood work-up including testing for human immunodeficiency virus (HIV), hepatitis, influenza A/B, Epstein-Barr virus (EBV), antinuclear antibodies (ANA) and autoantibodies against various extractable nuclear antigens (ENA) did not reveal evidence for viral originators or autoimmune diseases. This case indicates that in acute viral myositis associated with extreme CK elevation (>400,000 IU/L) AKI might be completely absent. Potential causes for this clinical phenotype, differential diagnosis and management are discussed.
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Affiliation(s)
- Antonia-Therese Kietaibl
- Department of 5th Internal Medicine with Endocrinology, Rheumatology and Gerontology with Outpatient Department, Clinic Ottakring, Montleartstraße 37, 1160, Vienna, Austria.
| | - Maria Fangmeyer-Binder
- Department of 5th Internal Medicine with Endocrinology, Rheumatology and Gerontology with Outpatient Department, Clinic Ottakring, Montleartstraße 37, 1160, Vienna, Austria
| | - Gabor Göndör
- Department of 6th Internal Medicine with Nephrology and Dialysis with Outpatient Department, Clinic Ottakring, Montleartstraße 37, 1160, Vienna, Austria
| | - Marcus Säemann
- Department of 6th Internal Medicine with Nephrology and Dialysis with Outpatient Department, Clinic Ottakring, Montleartstraße 37, 1160, Vienna, Austria
| | - Peter Fasching
- Department of 5th Internal Medicine with Endocrinology, Rheumatology and Gerontology with Outpatient Department, Clinic Ottakring, Montleartstraße 37, 1160, Vienna, Austria
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Brisca G, Mariani M, Pirlo D, Romanengo M, Pistorio A, Gaiero A, Panicucci C, Piccotti E, Bruno C. Management and outcome of benign acute childhood myositis in pediatric emergency department. Ital J Pediatr 2021; 47:57. [PMID: 33750449 PMCID: PMC7945053 DOI: 10.1186/s13052-021-01002-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Benign acute childhood myositis (BACM) is a self-limited syndrome associated with viral infections characterized by symmetric lower extremity pain typically affecting school-aged children. Evolution in rhabdomyolysis and kidney damage is rarely reported. Despite this, the acute presentation commonly concerns both parents and health care providers, often leading to unnecessary workup. The aim of the study was to determine the features and outcome of a large series of children with BACM identifying a management pathway for pediatricians in Emergency Department (ED). METHODS We conducted a retrospective study of patients with BACM managed in 2 Italian pediatric ED during a period of 8 and a half years. Demographic data, clinical, and laboratory results were extracted from electronic medical records. Recurrence, complications, treatments, and outcomes were also recorded. Descriptive statistics were produced for first-episode patients and for those with recurrence of myositis. A comparison between groups was performed. RESULTS One hundred and thirteen patients with BACM were identified. Ninety-two children (65 males) had a single episode, while ten (nine males) had recurrence. The mean age at presentation was 6.0 years (range 2-13,2). All patients had normal neurological examination and no one developed myoglobinuria, or renal failure. At first evaluation median CK level was 1413 UI/l (normal values < 150 U/L). Median CK of "recurrent" patients was higher than "non-recurrent" (2330 vs 1150 U/L, p = 0.009). Viral studies were positive in 51/74 cases, with high prevalence of Influenza viruses. Ninety-six patients (85%) were hospitalized with a median of 4 days. No patients had any residual muscular impairment. CONCLUSIONS BACM has an excellent prognosis. Severe pathological conditions can be excluded with a complete history and clinical examination and simple blood and urine tests, avoiding unnecessary diagnostic investigations. Most patients may be discharged home from ED recommending hydration, rest, analgesics and careful follow-up.
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Affiliation(s)
- Giacomo Brisca
- Subintensive Care Unit, IRCCS Istituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147, Genoa, Italy.
| | - Marcello Mariani
- Infectious Disease Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Daniela Pirlo
- Subintensive Care Unit, IRCCS Istituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Marta Romanengo
- Subintensive Care Unit, IRCCS Istituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Angela Pistorio
- Department of Epidemiology and Biostatistics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alberto Gaiero
- Pediatric and Neonatology Department, ASL2 Savonese, Savona, Italy
| | - Chiara Panicucci
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Emanuela Piccotti
- Pediatric Emergency Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Claudio Bruno
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Crowley LM, Mazzaccaro RJ, Dunn AL, Bauch SE, Greenberg MR. Don't Forget the Flu - Determining the Etiology of Infective Myositis in a Child: A Case Report. Clin Pract Cases Emerg Med 2021; 5:105-108. [PMID: 33560965 PMCID: PMC7872606 DOI: 10.5811/cpcem.2020.12.50405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/18/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Infective myositis is an acute, self-limited condition, rarely occurring in children with recent viral infections. The condition is often overlooked by emergency physicians when endeavoring to exclude other diagnoses included in the differential. Diagnosis of the condition can be difficult when based purely on clinical presentation because it shares symptoms with much more concerning neurological illnesses. A few simple laboratory tests are indicated to reach the correct diagnosis. Case Report The following case report describes a three-year-old female diagnosed with a recent upper respiratory tract infection presenting to the emergency department with complaints of fatigue and inability to walk. She was diagnosed with an influenza-like illness three days prior by her pediatrician, the symptoms of which had mostly resolved by the time of presentation. Conclusion Muscle weakness and abnormal, uncoordinated gait with an acute upper respiratory tract infection in a child may be cause for concern, prompting unnecessary work-up. Emergency physicians should be aware of the signs and symptoms of influenza-associated infective myositis in children, especially during influenza season.
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Affiliation(s)
- Lauren M Crowley
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania
| | - Richard J Mazzaccaro
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Lehigh Valley Health Network, Department of Pediatrics, Allentown, Pennsylvania
| | - Amy Lewis Dunn
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Division of Pediatric Emergency Medicine, Allenton, Pennsylvania
| | - Sarah E Bauch
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania
| | - Marna Rayl Greenberg
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania
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Wasserman PL, Way A, Baig S, Gopireddy DR. MRI of myositis and other urgent muscle-related disorders. Emerg Radiol 2020; 28:409-421. [PMID: 33169179 PMCID: PMC7652376 DOI: 10.1007/s10140-020-01866-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/22/2020] [Indexed: 01/18/2023]
Abstract
Myositis has many etiologies, and it can be encountered in the acute or chronic setting. Our goal is to increase the radiologist’s knowledge of myositis and other urgent muscle disorders encountered in the emergent or urgent setting. We review the clinical presentation, the MRI appearance, and the complications that can be associated with these entities. Since myositis can affect multiple muscle compartments, we review how to differentiate the compartments of the appendicular skeletal in order to generate reports that relay important anatomic information to the treating physician. Given the poor sensitivity and positive predictive value of the clinical signs and symptoms used to diagnosing acute compartment syndrome, we discuss the potential use of MRI in cases of suspected but clinically equivocal compartment syndrome in the future.
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Affiliation(s)
- Paul L Wasserman
- University of Florida-College of Medicine Jacksonville, 655 West 8th Street C90, Jacksonville, FL, 32209, USA.
| | - Ashley Way
- University of Florida-College of Medicine Jacksonville, 655 West 8th Street C90, Jacksonville, FL, 32209, USA
| | - Saif Baig
- University of Florida-College of Medicine Jacksonville, 655 West 8th Street C90, Jacksonville, FL, 32209, USA
| | - Dheeraj Reddy Gopireddy
- University of Florida-College of Medicine Jacksonville, 655 West 8th Street C90, Jacksonville, FL, 32209, USA
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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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Rousseau LA, Liu SW, Bhatia K, Miller ES. Sudden Weakness in A Young Healthy Man. J Emerg Med 2016; 51:725-728. [PMID: 27658553 DOI: 10.1016/j.jemermed.2016.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/19/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Lauren A Rousseau
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Kriti Bhatia
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emily S Miller
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
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Vijay MK, Vijay P, Kundu AK. Rhabdomyolysis and myogloginuric acute renal failure in the lithotomy/exaggerated lithotomy position of urogenital surgeries. Urol Ann 2011; 3:147-50. [PMID: 21976928 PMCID: PMC3183707 DOI: 10.4103/0974-7796.84965] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Accepted: 02/27/2011] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate rhabdomyolysis and it's management in lithotomy and the exaggerated lithotomy positions during urogenital surgeries. DESIGN Retrospective study SETTING Institute of Post Graduate Medical Education and Research (IPGME & R), Kolkata, India. MATERIALS AND METHODS Patients undergoing urogenital surgeries (lithotomy and the exaggerated lithotomy positions). INTERVENTION(S) All four cases of rhabdomyolysis which occurred after such positional urogenital surgeries were treated with conservative management for prolonged period with hemodialysis. One case which developed compartment syndrome underwent fasciotomy and also managed with conservative approach as other cases. MAIN OUTCOME MEASURE Rhabdomylysis is now a rare complication in any open or laparoscopic surgery. But prolonged lithotomy or exaggerated lithotomy position surgeries have been shown to expose patients to the risk of rhabdomylysis and acute renal failure. RESULTS In our institute patients undergoing urogenital surgeries in lithotomy and the exaggerated lithotomy positions only developed rhabdomyolysis and myogloginuric acute renal failure. All procedures were of prolonged duration (mean five hours and ten minutes). Three patients developed rhabdomyolysis and acute renal failure without compartmental syndrome and one with compartmental syndrome. Rhabdomyolysis with the appearance of acute renal failure is discussed. CONCLUSION Overall, our cases showed that rhabdomyolysis and acute renal failure can develop in such operative positions even in the absence of compartmental syndrome, and that duration of surgery is the most important risk factor for such complications. So we should be careful regarding duration of surgery in lithotomy procedure to prevent such morbid complications.
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Affiliation(s)
- Mukesh K Vijay
- Department of Urology, Institute of Postgraduate Medical Education and Research and SSKM Hospital, Kolkata, India
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Al Kindi M, Limaye V, Hissaria P. Meloxicam-induced rhabdomyolysis in the context of an acute ross river viral infection. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2011; 4:52-4. [PMID: 22211172 PMCID: PMC3242063 DOI: 10.4168/aair.2012.4.1.52] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 08/01/2011] [Indexed: 11/20/2022]
Abstract
Acute rhabdomyolysis is a clinical and laboratory syndrome resulting from the breakdown of skeletal muscle, with the release of intracellular contents into the circulatory system, which can cause potentially lethal complications. Here, we present the case of a patient who developed acute rhabdomyolysis after consumption of meloxicam for jaw pain and experienced generalized myalgias in the context of an acute febrile illness with generalized urticaria. Further investigation indicated elevated muscle enzymes and acute renal failure. Serological analysis revealed that the patient was positive for Ross River virus (RRV) IgM. Genetic studies to detect CYP2C9 polymorphisms were negative. Meloxicam was discontinued. He responded to conservative measures within 2 weeks. Oral aspirin challenge was negative, suggesting a drug-specific effect of meloxicam rather than a class effect. Our case indicates a causative role for meloxicam and/or acute RRV in rhabdomyolysis.
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Affiliation(s)
- Mahmood Al Kindi
- Department of Human Immunology, SA Pathology, Adelaide, Australia
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Al-Ismaili Z, Piccioni M, Zappitelli M. Rhabdomyolysis: pathogenesis of renal injury and management. Pediatr Nephrol 2011; 26:1781-8. [PMID: 21249398 DOI: 10.1007/s00467-010-1727-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 11/17/2010] [Accepted: 11/22/2010] [Indexed: 12/17/2022]
Affiliation(s)
- Zubaida Al-Ismaili
- Division of Nephrology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper, Room E-213, Montreal, QC, Canada, H3H 1P3
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Kumar K, Guirgis M, Zieroth S, Lo E, Menkis AH, Arora RC, Freed DH. Influenza myocarditis and myositis: case presentation and review of the literature. Can J Cardiol 2011; 27:514-22. [PMID: 21652168 DOI: 10.1016/j.cjca.2011.03.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 02/18/2011] [Indexed: 11/26/2022] Open
Abstract
Myocarditis, a general inflammatory condition of the heart muscle, can result from a variety of etiologies, the most common being viral. Despite common pathogens, concomitant myocarditis and myositis remains a rare event. Although a common cause of respiratory illness, extrapulmonary infections with influenza are infrequent. We describe the case of a patient who presented to our centre with concomitant "seasonal" H1N1 influenza A myocarditis further complicated by pan-myositis. The patient's condition rapidly declined, eventually requiring biventricular mechanical support, in addition to multilimb fasciotomies. The cardiac support required was progressive, from a percutaneous left ventricular assist device, to extracorporeal membrane oxygenation, to eventual biventricular assist device support for bridge-to-transplantation. This case motivated a detailed review of the literature (a total of 29 cases were identified), in which we found that patients with influenza myocarditis/myositis were predominantly female (63%) and young (mean age 33.2 years) and continue to have a high incidence of morbidity and mortality (27%). As a result of its atypical pattern, the 2009 H1N1 pandemic strain has gained attention. From our review, we found 7 patients with of 2009 H1N1 pandemic influenza myocarditis. Serial serum cytokine analysis did not demonstrate a "cytokine storm," which has been associated with other virulent influenza strains. The PB1-F2 marker in particular has been associated with a vigorous cytokine response. The 2009 H1N1 and "seasonal" influenza strains lack this marker. In those patients with community-acquired influenza, interleukin-6 has been shown to correlate with symptoms. For patients with myocarditis resulting in shock, mechanical circulatory support has gained acceptance as a means to recovery or transplantation.
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Affiliation(s)
- Kanwal Kumar
- Institute of Cardiovascular Sciences, St. Boniface Research Centre, Winnipeg, Manitoba, Canada
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Shah SV, Reddy K. Rhabdomyolysis with acute renal failure triggered by the seasonal flu vaccination in a patient taking simvastatin. BMJ Case Rep 2010; 2010:2010/oct01_1/bcr1120092485. [PMID: 22778082 DOI: 10.1136/bcr.11.2009.2485] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A man in his 70s presented with bilateral, painful legs and feeling generally unwell following the seasonal flu vaccination. The patient had a background of B cell lymphoma in partial remission. His current medications included simvastatin. Initial investigations revealed rhabdomyolysis and acute renal failure. He was admitted to critical care for renal replacement treatment. Other causes of rhabdomyolysis were excluded and expert opinion agreed that the most likely cause was the influenza vaccination with the concurrent use of simvastatin. The patient's renal function gradually normalised and after several months the patient has regained full power in his legs.
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Affiliation(s)
- S V Shah
- Intensive Care Department, University Hospital Lewisham, London, UK.
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