Benign acute childhood myositis

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Benign acute childhood myositis (BACM) is a syndrome characterized by muscle weakness and pain in the lower limbs that develop in children after a recent viral illness. It is transient with a spontaneous clinical resolution within 1 week. [1] [2]

Contents

Symptoms

Prodromal symptoms are typically fever, cough, and rhinorrhea. BACM symptoms that follow are most frequently calf pain, gait complaints, and inability to walk. [2] The condition is self-limited and full restitution can be expected. In very rare cases, however, rhabdomyolysis may develop. [1]

Affected are preschool and school-age children with a male predominance. [2] In one study, the median age was 6 years (range 2–13.2 years). [1] It has been estimated that BACM has an incidence of 2.69 cases per 100,000 children (<18 years) during epidemic seasons and 0.23 cases during non-epidemic seasons. [3]

Diagnosis

The history of a preceding influenza-like infection followed by the typical symptoms of acute onset of symmetrical calf pain and gait problems together with an isolated finding of a high level of creatine kinase suggests the diagnosis of BACM. [4] Myoglobinuria is rare and points to the possibility of the development of rhabdomyolysis and kidney failure. [2] [5]

Guillain-Barré syndrome (GBS) is the main consideration in the differential diagnosis. It needs to be quickly excluded as early intervention in GBS is indicated. Other conditions under possible consideration are dermatomyositis, muscular dystrophy, juvenile idiopathic arthritis, transient synovitis of the hip, osteomyelitis, and myalgia. [1]

Few muscle biopsies have been conducted. Results may show normal findings or features of inflammation and necrosis. [1]

Preceding viral infections

A number of different preceding viral infections have been reported, most commonly influenza A and B. The condition appears to be more prevalent during late fall, winter, and spring. [2] Other virus infections that have been linked to BACM are those caused by Parainfluenza, Coxsackievirus, Adenovirus, Echovirus, and Mycoplasma pneumonia. [1] Viral myositis after viral infections may also occur in adults, and viruses, such as COVID-19, have been reported as a rare cause of myositis. [6]

Management

BACM may be alarming to parents and lead to unnecessary extensive tests. [4] Treatment consists of oral analgesics, rest, and adequate hydration. [1] Hospitalization is usually not necessary. Full recovery can be expected within a week, however, recurrences can occur.

History

in 1957 Lundberg reported on a group of patients with a condition he named myalgia cruris epidemica, [7] seemingly the first description of BACM. Other terms later used include influenza-associated myositis, viral myositis, acute myositis [2] Middleton and colleagues reported on BACM as severe myositis after influenza in 1970. [8] Viral myositis may occur also in later years.

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References

  1. 1 2 3 4 5 6 7 Brisca G, Mariani M, Pirlo D, et al. (2021). "Management and outcome of benign acute childhood myositis in pediatric emergency department". Italian Journal of Pediatrics. 47 (1): 307–317. doi: 10.1186/s13052-021-01002-x . PMC   7945053 . PMID   123455. S2CID   232146322.
  2. 1 2 3 4 5 6 Costa Azevedo A, Costa E Silva A, Juliana Silva C, Poço Miranda S, Costa M, Martinho I (2022). "Benign acute childhood myositis: A 5-year retrospective study". Arch Pediatr. 29 (7): 490–493. doi:10.1016/j.arcped.2022.08.009. PMID   36109287. S2CID   252242350.
  3. ↑ Buss BF, Shinde VM, Safranek TJ, Uyeki TM (2009). "Pediatric influenza-associated myositis - Nebraska, 2001-2007". Influenza Other Respir Viruses. 3 (6): 277–85. doi:10.1111/j.1750-2659.2009.00102.x. PMC   4941392 . PMID   19903210.
  4. 1 2 Chu EC, Yip AS (2019). "A rare presentation of benign acute childhood myositis". Clin Case Rep. 7 (3): 461–464. doi:10.1002/ccr3.2001. PMC   6406135 . PMID   30899472.
  5. ↑ Cassim F, Soni AJ, Murphy S (2021). "Severe acute inflammatory myositis and rhabdomyolysis in paediatric SARS-CoV-2-associated MIS-C (multisystem inflammatory syndrome in children)". BMJ Case Reports. 14 (8): e243112. doi:10.1136/bcr-2021-243112. PMC   8354289 . PMID   34373240.
  6. ↑ Saud A, Naveen R, Aggarwal R, Gupta L (July 2021). "COVID-19 and Myositis: What We Know So Far". Current Rheumatology Reports. 23 (8): 63. doi:10.1007/s11926-021-01023-9. PMC   8254439 . PMID   34216297.
  7. ↑ Lundberg A (1957). "Myalgia cruris epidemica". Acta Paediatr (Stockh). 46 (1): 18–31. doi:10.1111/j.1651-2227.1957.tb08627.x. PMID   13410584. S2CID   6590371.
  8. ↑ Middleton PJ, Alexander RM, Szymanski MT (1970). "Severe myositis during recovery from influenza". Lancet. 2 (7672): 533–5. doi:10.1016/s0140-6736(70)91343-7. PMID   4195201.
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