Benign Acute Childhood Myositis: Our Experience on Clinical Evaluation

Silvia D'Amico; Gloria Gangi; Massimo Barbagallo; Toni Palermo; Maria Carla Finocchiaro; Antonella Distefano; Raffaele Falsaperla; Silvia Marino; Filippo Greco; Pierluigi Smilari; Piero Pavone

doi:10.1055/a-1792-7606

Neuropediatrics, Table of Contents

Neuropediatrics 2022; 53(06): 418-422
DOI: 10.1055/a-1792-7606

Original Article

Benign Acute Childhood Myositis: Our Experience on Clinical Evaluation

Silvia D'Amico‡^*

¹Department of Clinical and Experimental Medicine, Postgraduate Training Program in Pediatrics, University of Catania, Catania, Italy

,

Gloria Gangi‡^*

¹Department of Clinical and Experimental Medicine, Postgraduate Training Program in Pediatrics, University of Catania, Catania, Italy

,

Massimo Barbagallo

²Pediatric Unit, Azienda di rilievo nazionale ARNAS “Garibaldi,” Catania, Italy

,

Toni Palermo

²Pediatric Unit, Azienda di rilievo nazionale ARNAS “Garibaldi,” Catania, Italy

,

Maria Carla Finocchiaro

³Pediatric General and Emergency Operative Unit, Cannizzaro Hospital, Catania, Italy

,

Antonella Distefano

³Pediatric General and Emergency Operative Unit, Cannizzaro Hospital, Catania, Italy

,

Raffaele Falsaperla

⁴Department of Clinical and Experimental Medicine, University Hospital “Policlinico-San Marco,” Catania, Italy

,

Silvia Marino

⁴Department of Clinical and Experimental Medicine, University Hospital “Policlinico-San Marco,” Catania, Italy

,

Filippo Greco

⁵Unit of Pediatrics and Pediatric Emergency, AOU “Policlinico,” PO “San Marco,” University of Catania, Catania, Italy

,

Pierluigi Smilari

⁵Unit of Pediatrics and Pediatric Emergency, AOU “Policlinico,” PO “San Marco,” University of Catania, Catania, Italy

,

Piero Pavone

⁵Unit of Pediatrics and Pediatric Emergency, AOU “Policlinico,” PO “San Marco,” University of Catania, Catania, Italy

› Author Affiliations

Abstract

Background Benign acute childhood myositis (BACM) is a transient condition mainly affecting children of school age characterized by muscle pain, typically localized to the calf muscle with symmetrical lower extremity pain and difficulty in walking. Usually, the symptomatology is preceded by a viral infection including influenza, parainfluenza, rotavirus, and mycoplasma.

Methods The case series was conducted in four pediatric hospitals in Catania, Italy, over a 12-year observational period. Clinical examination, laboratory data, course, treatment, and complications of the affected children were extracted from electronic medical records of each hospital.

Results For the case series, 50 children diagnosed with BACM were enrolled: the mean age of affected children was 5.35 years, 86% of were males, and in 56% the affections occurred during the winter. In the affected children, the clinical picture was characterized by previous fever and/or symptoms of inflammation of the upper airways, and followed by pain in the lower extremities up to uncoordinated gait. In 17 cases the etiological agent was isolated, including the influenza virus type B as the most frequent and influenza virus type A, Mycoplasma pneumoniae, beta-hemolytic streptococcus, and herpes simplex virus. Children were treated with supportive therapy. In all the children the muscular symptomatology had a good evolution with progressive marked reduction of pain and of the high level of CKemia. Neither clinical recurrences nor sequelae were reported.

Conclusion BACM shows to have in most of the cases a favorable evolution, a spontaneous remission of symptoms, and a good prognosis. However, the disorder generates parental distress for the acute presentation and the striking muscle dysfunction. It is worthy a rapid and early diagnosis to avoid unnecessary diagnostic investigations and a careful follow-up necessary to exclude persistence of symptoms or creatine kinase elevation.

Keywords

myositis - rhabdomyolysis - renal damage - hyperCKemia - muscle disorder

Full Text

References

References
1 Lundberg A. Myalgia cruris epidemica. Acta Paediatr (Stockh) 1957; 46 (01) 18-31
2 Cavagnaro S M F, Aird G A, Harwardt R I, Marambio Q CG. Benign acute childhood myositis: clinical series and literature review [in Spanish]. Rev Chil Pediatr 2017; 88 (02) 268-274
3 Mall S, Buchholz U, Tibussek D. et al. A large outbreak of influenza B-associated benign acute childhood myositis in Germany, 2007/2008. Pediatr Infect Dis J 2011; 30 (08) e142-e146
4 Mackay MT, Kornberg AJ, Shield LK, Dennett X. Benign acute childhood myositis: laboratory and clinical features. Neurology 1999; 53 (09) 2127-2131
5 Agyeman P, Duppenthaler A, Heininger U, Aebi C. Influenza-associated myositis in children. Infection 2004; 32 (04) 199-203
6 Bove KE, Hilton PK, Partin J, Farrell MK. Morphology of acute myopathy associated with influenza B infection. Pediatr Pathol 1983; 1 (01) 51-66
7 Mejlszenkier JD, Safran AP, Healy JJ, Embree L, Ouellette EM. The myositis of influenza. Arch Neurol 1973; 29 (06) 441-443
8 Ruff RL, Secrist D. Viral studies in benign acute childhood myositis. Arch Neurol 1982; 39 (05) 261-263
9 Miller DT, Ment LR. Case report: a young boy with painful leg swelling. Curr Opin Pediatr 2002; 14 (06) 731-734
10 Ishigaki C, Patria SY, Nishio H, Yabe M, Matsuo M. A Japanese boy with myalgia and cramps has a novel in-frame deletion of the dystrophin gene. Neurology 1996; 46 (05) 1347-1350
11 Antony JH, Procopis PG, Ouvrier RA. Benign acute childhood myositis. Neurology 1979; 29 (07) 1068-1071
12 Brisca G, Mariani M, Pirlo D. et al. Management and outcome of benign acute childhood myositis in pediatric emergency department. Ital J Pediatr 2021; 47 (01) 57
13 Dandolo A, Banerjee A. Myosite aiguë focale chez un adolescent. Arch Pediatr 2013; 20 (07) 779-782
14 Terlizzi V, Improta F, Raia V. Simple diagnosis of benign acute childhood myositis: lessons from a case report. J Pediatr Neurosci 2014; 9 (03) 280-282
15 Chu EC, Yip AS. A rare presentation of benign acute childhood myositis. Clin Case Rep 2019; 7 (03) 461-464
16 Padrón Hernández ML, Vargas Latorre JR, Ortegón-Ochoa S, Naranjo-Medina N, Pacheco B. Viral myositis, a pediatric case report [in Spanish]. Arch Argent Pediatr 2019; 117 (05) e493-e496
17 Choi S-W, Ko H. Benign acute childhood myositis: perplexing complication after acute viral pharyngitis. Korean J Fam Med 2018; 39 (06) 375-378
18 Mizuta K, Aoki Y, Komabayashi K. et al. Parechovirus A3 (PeV-A3)-associated myalgia/myositis occurs irrespective of its genetic cluster: a longitudinal molecular epidemiology of PeV-A3 in Yamagata, Japan between 2003 and 2016. J Med Microbiol 2019; 68 (03) 424-428
19 Yamamoto K, Fukuda S, Mushimoto Y. et al. Acute myositis associated with concurrent infection of rotavirus and norovirus in a 2-year-old girl. Pediatr Rep 2015; 7 (03) 5873
20 Belardi C, Roberge R, Kelly M, Serbin S. Myalgia cruris epidemica (benign acute childhood myositis) associated with a Mycoplasma pneumonia infection. Ann Emerg Med 1987; 16 (05) 579-581
21 Tekin E, Akoğlu HA. From influenza to SARS-CoV-2: etiological evaluation of acute benign childhood myositis. Acta Neurol Belg 2021;1–5
22 Yang X, Yu Y, Xu J. et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020; 8 (05) 475-481
23 Wang D, Hu B, Hu C. et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA 2020; 323 (11) 1061-1069
24 Chen N, Zhou M, Dong X. et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395 (10223): 507-513
25 Xu XW, Wu XX, Jiang XG. et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ 2020; 368: m606
26 Magee H, Goldman RD. Viral myositis in children. Can Fam Physician 2017; 63 (05) 365-368
27 Neocleous C, Spanou C, Mpampalis E. et al. Unnecessary diagnostic investigations in benign acute childhood myositis: a case series report. Scott Med J 2012; 57 (03) 182
28 Ferrarini A, Lava SA, Simonetti GD, Ramelli GP, Bianchetti MG. Swiss Italian Society of Pediatrics. Influenza virus B-associated acute benign myalgia cruris: an outbreak report and review of the literature. Neuromuscul Disord 2014; 24 (04) 342-346
29 Ekşioğlu AS, Akca Çağlar A, Kaynak Şahap S, Karacan CD, Tuygun N. Value of strain-wave sonoelastography as an imaging modality in assessment of benign acute myositis in children. Turk J Med Sci 2021; 51 (06) 2951-2958
30 Torres PA, Helmstetter JA, Kaye AM, Kaye AD. Rhabdomyolysis: pathogenesis, diagnosis, and treatment. Ochsner J 2015; 15 (01) 58-69