1
|
Pace M, Cannella R, Di Stefano V, Lupica A, Alonge P, Morici G, Brighina F, Brancato F, Midiri F, Galia M. Usefulness and Clinical Impact of Whole-Body MRI in Detecting Autoimmune Neuromuscular Disorders. Brain Sci 2023; 13:1500. [PMID: 37891867 PMCID: PMC10605918 DOI: 10.3390/brainsci13101500] [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: 08/22/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
Autoimmune neuromuscular diseases are a group of heterogenous pathologies secondary to the activation of the immune system that damage the structures of the peripheric nerve, the neuromuscular junction, or the skeleton muscle. The diagnosis of autoimmune neuromuscular disorders comprises a combination of data from clinical, laboratory, electromyography, imaging exam, and biopsy. Particularly, the whole-body MRI examination in the last two decades has been of great use in the assessment of neuromuscular disorders. MRI provides information about the structures involved and the status of activity of the disease. It can also be used as a biomarker, detect the pattern of specific muscle involvement, and is a useful tool for targeting the optimal muscle site for biopsy. In this work, we summarized the most used technical protocol of whole-body MRI and the role of this imaging technique in autoimmune neuromuscular disorders.
Collapse
Affiliation(s)
- Mario Pace
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (M.P.); (R.C.); (G.M.)
| | - Roberto Cannella
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (M.P.); (R.C.); (G.M.)
| | - Vincenzo Di Stefano
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (V.D.S.); (A.L.); (P.A.); (F.B.)
| | - Antonino Lupica
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (V.D.S.); (A.L.); (P.A.); (F.B.)
| | - Paolo Alonge
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (V.D.S.); (A.L.); (P.A.); (F.B.)
| | - Giulio Morici
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (M.P.); (R.C.); (G.M.)
| | - Filippo Brighina
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (V.D.S.); (A.L.); (P.A.); (F.B.)
| | - Federica Brancato
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, 90133 Palermo, Italy;
| | - Federico Midiri
- IRCCS Ospedale Galeazzi-Sant’Ambrogio, Via Cristina Belgioioso 173, 20161 Milano, Italy;
| | - Massimo Galia
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (M.P.); (R.C.); (G.M.)
| |
Collapse
|
2
|
Ghanbarnasab M, Nejati P, Moeinoddin R, Nejati L. The Effect of High-Intensity Laser Therapy on Trapezius Focal Myositis: A Rare Case Report. J Lasers Med Sci 2019; 10:346-349. [PMID: 31875130 DOI: 10.15171/jlms.2019.56] [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: 11/09/2022]
Abstract
Focal myositis (FM) is a rare inflammatory myopathy characterized by a painful swelling of a skeletal muscle. The lower limb is the most common site for FM, but it has also been reported in the abdomen, forearm, neck, and tongue musculature. Some conservative treatments such as non-steroidal anti-inflammatory drugs, physiotherapy, and steroids can relieve muscle pain and its minor complications. This report describes a patient who had shoulder pain and was diagnosed with FM in the left trapezius muscle with an excellent response to high-intensity laser therapy.
Collapse
Affiliation(s)
- Maryam Ghanbarnasab
- Sports Medicine Department, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Parisa Nejati
- Sports Medicine Department, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Moeinoddin
- Dr. Moeinoddin Radiology and Sonography Clinic, Qazvin, Iran
| | - Lida Nejati
- Islamic Azad University, Science and Research Branch, Tehran, Iran
| |
Collapse
|
3
|
Cadena I, Werth VP, Levine P, Yang A, Downey A, Curtin J, Muggia F. Lasting pathologic complete response to chemotherapy for ovarian cancer after receiving antimalarials for dermatomyositis. Ecancermedicalscience 2018; 12:837. [PMID: 29910834 PMCID: PMC5985755 DOI: 10.3332/ecancer.2018.837] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Indexed: 01/07/2023] Open
Abstract
Could hydroxychloroquine and quinacrine antimalarial therapy for dermatomyositis later attributed to a paraneoplasic manifestation of an ovarian cancer enhance its subsequent response to chemotherapy? Five months after being diagnosed with dermatomyositis, while somewhat improved with hydroxychloroquine, quinacrine and methotrexate, this 63-year-old woman presented with an advanced intra-abdominal epithelial ovarian cancer documented (but not resected) at laparotomy. Neoadjuvant carboplatin/paclitaxel resulted in remarkable improvement of symptoms, tumour markers and imaging findings leading to thorough cytoreductive surgery at completion of five cycles. No tumour was found in the resected omentum, gynaecologic organs, as well as hepatic and nodal sampling thus documenting a complete pathologic response; a subcutaneous port and an intraperitoneal (IP) catheter were placed for two cycles of IP cisplatin consolidation. She remains free of disease 3 years after such treatment and her dermatomyositis is in remission in the absence of any treatment. We discuss a possible role of autophagy in promoting tumour cell survival and chemoresistance that is potentially reversed by antimalarial drugs. Thus, chemotherapy following their use may subsequently lead to dramatic potentiation of anticancer treatment.
Collapse
Affiliation(s)
| | | | | | - Annie Yang
- New York University, New York, NY 10003, USA
| | | | - John Curtin
- New York University, New York, NY 10003, USA
| | | |
Collapse
|
4
|
Wang J, Jiao J, Zhao G, Shi J, Xia J. Case report: A rare case of focal myositis presenting as Sartorius muscle contracture: A case report and review of literature. Medicine (Baltimore) 2018; 97:e10766. [PMID: 29768366 PMCID: PMC5976314 DOI: 10.1097/md.0000000000010766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
RATIONALE Focal myositis (FM) is a very rare myopathy of unknown etiology characterized by focal enlargement within one single skeletal muscle. In particular, it occurs only involving the Sartorius muscle has never been reported. PATIENT CONCERNS A 25-year-old man was admitted to the hospital with progressive restricted left hip joint extension, left thigh discomfort and gait disturbance for 6 years. DIAGNOSES Combining clinical manifestations with results of radiological and pathological examinations, it was consistent with the diagnosis of FM INTERVENTIONS:: The patient received a surgery under general anesthesia to release the contracted Sartorius tendon. OUTCOMES The range of motion of the patient's left hip and ipsilateral knee has significantly improved as well as the discomfort of his left thigh relieved obviously after the surgery. LESSONS This case report is the first to report FM presenting as sartorius muscle contracture and the surgery is an alternative therapy for these patients.
Collapse
|
5
|
Gallay L, Hot A, Petiot P, Thivolet-Bejui F, Maucort-Boulch D, Streichenberger N. Focal myositis: New insights on diagnosis and pathology. Neurology 2018; 90:e1013-e1020. [PMID: 29467303 DOI: 10.1212/wnl.0000000000005160] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 12/20/2017] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To better define in a cohort study the clinical and pathologic features of focal myositis (FM). METHODS With the use of the usual clinicopathologic definition, each confirmed case of FM in the Lyon University Hospital's myopathologic database between 2000 and 2016 was retrieved. Clinical, pathologic, imaging, serologic, and therapeutic data were collected. When data were missing but feasible, appropriate pathologic analyses were performed. RESULTS Of the 924 patients included in the database, 37 (4%) had confirmed FM (14 female, 23 male patients). The main symptoms were pain (n = 30, 81%), muscular mass (n = 16, 43%), erythema at the site of FM (n = 12, 32%), and fever (n = 9, 24%). Serum creatine kinase was normal in most patients (81%); serum immune abnormalities were frequent (inflammatory syndrome in sera [39%], dysglobulinemia [52%], and anti-nuclear antibody positivity [29%]). In addition to confirming previously reported findings, pathologic analyses found significant rates of vasculitis (68%) and fasciitis (73%). Here, FM appeared frequently to be associated with other diseases such as immune-mediated inflammatory disease (IMID; 32%), neoplasia (24%), and radiculopathy (11%). Regarding outcomes, 64% of the cases had received immunosuppressive drugs, and the relapse rate was 41%. CONCLUSION The present study suggests that FM is not as innocuous as previously believed, particularly considering the associated disorders. Notably, patients with FM should receive careful IMID and neoplasia screening.
Collapse
Affiliation(s)
- Laure Gallay
- From the Department of Internal Medicine (L.G., A.H.), Edouard Herriot University Hospital, Hospices Civils de Lyon; University Claude Bernard (L.G., A.H., F.T.-B., N.S.); INMG (L.G.), CNRS UMR 5310-INSERM U1217; Department of Neurology (P.P.), Croix-Rousse Hospital, Hospices Civils de Lyon; Department of Pathology, Neurology and Neurosurgery (F.T.-B., N.S.), Pierre Wertheimer University Hospital, Hospices Civils de Lyon; Service de Biostatistique (D.M.-B.), Hospices Civils de Lyon; Université de Lyon (D.M.-B.); Université Lyon 1 (D.M.-B.); and CNRS UMR5558 (D.M.-B.), Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France.
| | - Arnaud Hot
- From the Department of Internal Medicine (L.G., A.H.), Edouard Herriot University Hospital, Hospices Civils de Lyon; University Claude Bernard (L.G., A.H., F.T.-B., N.S.); INMG (L.G.), CNRS UMR 5310-INSERM U1217; Department of Neurology (P.P.), Croix-Rousse Hospital, Hospices Civils de Lyon; Department of Pathology, Neurology and Neurosurgery (F.T.-B., N.S.), Pierre Wertheimer University Hospital, Hospices Civils de Lyon; Service de Biostatistique (D.M.-B.), Hospices Civils de Lyon; Université de Lyon (D.M.-B.); Université Lyon 1 (D.M.-B.); and CNRS UMR5558 (D.M.-B.), Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Philippe Petiot
- From the Department of Internal Medicine (L.G., A.H.), Edouard Herriot University Hospital, Hospices Civils de Lyon; University Claude Bernard (L.G., A.H., F.T.-B., N.S.); INMG (L.G.), CNRS UMR 5310-INSERM U1217; Department of Neurology (P.P.), Croix-Rousse Hospital, Hospices Civils de Lyon; Department of Pathology, Neurology and Neurosurgery (F.T.-B., N.S.), Pierre Wertheimer University Hospital, Hospices Civils de Lyon; Service de Biostatistique (D.M.-B.), Hospices Civils de Lyon; Université de Lyon (D.M.-B.); Université Lyon 1 (D.M.-B.); and CNRS UMR5558 (D.M.-B.), Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Françoise Thivolet-Bejui
- From the Department of Internal Medicine (L.G., A.H.), Edouard Herriot University Hospital, Hospices Civils de Lyon; University Claude Bernard (L.G., A.H., F.T.-B., N.S.); INMG (L.G.), CNRS UMR 5310-INSERM U1217; Department of Neurology (P.P.), Croix-Rousse Hospital, Hospices Civils de Lyon; Department of Pathology, Neurology and Neurosurgery (F.T.-B., N.S.), Pierre Wertheimer University Hospital, Hospices Civils de Lyon; Service de Biostatistique (D.M.-B.), Hospices Civils de Lyon; Université de Lyon (D.M.-B.); Université Lyon 1 (D.M.-B.); and CNRS UMR5558 (D.M.-B.), Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Delphine Maucort-Boulch
- From the Department of Internal Medicine (L.G., A.H.), Edouard Herriot University Hospital, Hospices Civils de Lyon; University Claude Bernard (L.G., A.H., F.T.-B., N.S.); INMG (L.G.), CNRS UMR 5310-INSERM U1217; Department of Neurology (P.P.), Croix-Rousse Hospital, Hospices Civils de Lyon; Department of Pathology, Neurology and Neurosurgery (F.T.-B., N.S.), Pierre Wertheimer University Hospital, Hospices Civils de Lyon; Service de Biostatistique (D.M.-B.), Hospices Civils de Lyon; Université de Lyon (D.M.-B.); Université Lyon 1 (D.M.-B.); and CNRS UMR5558 (D.M.-B.), Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Nathalie Streichenberger
- From the Department of Internal Medicine (L.G., A.H.), Edouard Herriot University Hospital, Hospices Civils de Lyon; University Claude Bernard (L.G., A.H., F.T.-B., N.S.); INMG (L.G.), CNRS UMR 5310-INSERM U1217; Department of Neurology (P.P.), Croix-Rousse Hospital, Hospices Civils de Lyon; Department of Pathology, Neurology and Neurosurgery (F.T.-B., N.S.), Pierre Wertheimer University Hospital, Hospices Civils de Lyon; Service de Biostatistique (D.M.-B.), Hospices Civils de Lyon; Université de Lyon (D.M.-B.); Université Lyon 1 (D.M.-B.); and CNRS UMR5558 (D.M.-B.), Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| |
Collapse
|
6
|
Gallay L, Streichenberger N, Benveniste O, Allenbach Y. [Focal myositis: An unknown disease]. Rev Med Interne 2017; 38:679-684. [PMID: 28947258 DOI: 10.1016/j.revmed.2017.06.015] [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: 04/18/2017] [Accepted: 06/12/2017] [Indexed: 11/29/2022]
Abstract
Focal myositis are inflammatory muscle diseases of unknown origin. At the opposite from the other idiopathic inflammatory myopathies, they are restricted to a single muscle or to a muscle group. They are not associated with extramuscular manifestations, and they have a good prognosis without any treatment. They are characterized by a localized swelling affecting mostly lower limbs. The pseudo-tumor can be painful, but is not associated with a muscle weakness. Creatine kinase level is normal. Muscle MRI shows an inflammation restricted to a muscle or a muscle group. Muscle biopsy and pathological analysis remain necessary for the diagnosis, showing inflammatory infiltrates composed by macrophages and lymphocytes without any specific distribution within the muscle. Focal overexpression of HLA-1 by the muscle fibers is frequently observed. The muscle biopsy permits to rule out differential diagnosis such a malignancy (sarcoma). Spontaneous remission occurs within weeks or months after the first symptoms, relapse is unusual.
Collapse
Affiliation(s)
- L Gallay
- Centre de pathologie et neuropathologie Est, hospices civils de Lyon, 69004 Lyon, France; Institut neuromyogène, CNRS UMR 5310, Inserm U1217, 69622 Villerbanne, France
| | - N Streichenberger
- Centre de pathologie et neuropathologie Est, hospices civils de Lyon, 69004 Lyon, France; Institut neuromyogène, CNRS UMR 5310, Inserm U1217, 69622 Villerbanne, France; Université Claude-Bernard-Lyon 1, 69622 Villerbanne, France
| | - O Benveniste
- Département de médecine interne et immunologie clinique, groupe hospitalier Pitié-Salpêtrière, centre de référence des maladies neuromusculaires Paris-Est, hôpital Pitié-Salpêtrière, Sorbonne universités, UPMC université Paris 06, AP-HP, 80, boulevard de l'Hôpital, 75013 Paris, France; UMR974, centre de recherche en myologie, Inserm, université Pierre-et-Marie-Curie, Sorbonnes universités, 75013 Paris, France
| | - Y Allenbach
- Département de médecine interne et immunologie clinique, groupe hospitalier Pitié-Salpêtrière, centre de référence des maladies neuromusculaires Paris-Est, hôpital Pitié-Salpêtrière, Sorbonne universités, UPMC université Paris 06, AP-HP, 80, boulevard de l'Hôpital, 75013 Paris, France; UMR974, centre de recherche en myologie, Inserm, université Pierre-et-Marie-Curie, Sorbonnes universités, 75013 Paris, France.
| |
Collapse
|
7
|
Milani GP, Mazzoni MBM, Gatti H, Bertolozzi G, Fossali EF. Recurrent Focal Myositis in Childhood: A Case Report and Systematic Review of the Literature. Pediatr Neurol 2017; 71:77-81.e1. [PMID: 28476523 DOI: 10.1016/j.pediatrneurol.2017.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 12/24/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Recurrent focal myositis in adulthood has been documented in case reports and case series. Existing textbooks and reviews do not mention or mention only in passing this entity in childhood. We present a patient with recurrent focal myositis and summarize available clinical, laboratory, management, and outcome data on this entity in the pediatric ages. METHOD We describe a nine-year-old patient with recurrent myositis of the left biceps. The terms "myositis" and "relapsing" or "recurrent" or "recurrence" were searched using the United States National Library of Medicine and the Excerpta Medica Database. Pertinent secondary references were also screened. RESULTS Another seven pediatric patients (five males and two females, median age ten years, interquartile range 7-14 years) with recurrent focal myositis were identified. In children, the calf was the most frequently involved muscle. Unlike adults, the myositis in children was usually painful. Episodes could be associated with normal or elevated erythrocyte sedimentation rate and blood levels of C-reactive protein, creatine kinase, and aspartate aminotransferase. Abnormalities of the creatine kinase value did not seem to be associated with a higher risk of recurrences. CONCLUSIONS Focal myositis has a favorable outcome in children. Recurrent focal myositis is rare and usually benign in childhood. More data are needed to improve the understanding of this condition.
Collapse
Affiliation(s)
- Gregorio P Milani
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
| | - Marta B M Mazzoni
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Helga Gatti
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Bertolozzi
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emilio F Fossali
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
8
|
Tahara J, Shinozuka J, Awaguni H, Tanaka SI, Makino S, Maruyama R, Imashuku S. Mild Encephalopathy with Reversible Lesions in the Splenium of Corpus Callosum and Bilateral Cerebral Deep White Matter in Identical Twins. Pediatr Rep 2016; 8:6615. [PMID: 27777703 PMCID: PMC5066098 DOI: 10.4081/pr.2016.6615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 11/23/2022] Open
Abstract
Identical twin brothers developed mild encephalopathy at the age of 7.0 and 9.7 years (Patient 1) and 10.7 years (Patient 2). Patient 1 had influenza A at the time of his second episode, but triggering agents were not evident at the first episode. The triggering agents in Patient 2 were unclear. The neurological features of both patients included transient facial numbness, left arm paresis, dysarthria, and gait disturbance. Diffusion-weighted images from magnetic resonance imaging showed high signal levels at the splenium of corpus callosum and in the bilateral cerebral deep white matter. These results are characteristic of mild encephalitis/encephalopathy with a reversible isolated splenium of corpus callosum lesion. All three episodes were treated with a methylprednisolone pulse. Acyclovir was also administered to Patient 2 and to Patient 1 during his first episode. Patient 1 received an anti-influenza agent and intravenous immunoglobulin during his second episode. Both patients recovered completely without sequelae. Genetic factors, which may predispose identical twins to develop encephalopathy, are discussed.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Shinsaku Imashuku
- Division of Laboratory Medicine, Uji-Tokushukai Medical Center , Uji, Kyoto, Japan
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
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.
Collapse
Affiliation(s)
- Hiroko Nagafuchi
- Division of Rheumatology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | | | | | | | | | | | | | | |
Collapse
|
11
|
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]
|