Bilateral recurrent focal myositis of gastrocnemius muscles after BCG vaccination

Manganelli, Stefania; Stefano, Renato De; Malandrini, Alessandro; Selvi, E.; Frati, E.; Gambelli, Simona; Marcolongo, R

doi:10.1093/rheumatology/41.9.1074

Cited by 17 publications

(16 citation statements)

References 11 publications

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“…Though cases of myositis have been described in adults after hepatitis B or BCG vaccination [13,14], cases linking the influenza vaccine to myositis are rare without confounding factors. Although an argument can be made regarding the patient's pneumonia as a possible confounder, we found no evidence in the literature to suggest that respiratory infections can result in acute skeletal and cardiac myopathies.…”

Section: Discussionmentioning

confidence: 99%

Post-Vaccination Myositis and Myocarditis in a Previously Healthy Male

Cheng¹,

Kozoriz²,

Ahmadi³

et al. 2015

Intern Med

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Rhabdomyolysis is the breakdown of muscle cells leading to the release of cellular constituents such as electrolytes, enzymes and myoglobin. There is a broad differential diagnosis for this condition. In this report we describe a 65 year old male who presented with weakness, rhabdomyolysis, and acute kidney injury five days after receiving the seasonal flu vaccine. Laboratory investigations showed elevated creatine kinase and troponin-I, and extensive cardiac investigations yielded a diagnosis of myocarditis. The cause of his clinical picture is explored in this case report. Case PresentationA 65 year old previously healthy male presented to hospital with profound weakness. Five days before admission he had received the seasonal influenza vaccine, comprised of one influenza A H1/N1 virus, one influenza A H3/N2 virus and one influenza B virus. Two days later, he developed bilateral crampy leg pain, muscle tenderness and weakness that progressed until the day of admission. He became unable to weight-bear and was brought to the emergency department by his wife. He denied symptoms of headaches, paresthesias, arthralgias or any new rash. An infectious review of systems was unremarkable and he did not have any constitutional symptoms. He was not taking any medications or herbal preparations prior to admission, and did not use recreational drugs.On physical exam his vitals were: P 92, BP 124/84, RR 20, T 36.7°C and his O 2 saturation was 100% on room air. His neurological exam was significant for 4/5 strength in the hip flexors, hip extensors, hip abductors and hip adductors. He could not stand from the sitting position without the aid of his arms. The muscles of his arms and legs were also tender. His cardiac examination revealed a jugular venous pressure (JVP) two cm above the sternal angle. His apical beat was normal. Auscultation revealed a normal S1 and S2 without any extra sounds, murmurs or rubs. His respiratory exam revealed mild crackles in the left lower lung zone. The rest of the examination was unremarkable.His blood counts were WBC 11 × 99/L, hemoglobin 123 g/L (MCV 83 fL) and platelets 134 × 109/L. Electrolytes included sodium 126 mmol/L, potassium 3.2 mmol/L, chloride 101 mmol/L, bicarbonate 17 mmol/L, phosphate 0.75 mmol/L and magnesium 0.97 mmol/L. Other investigations showed urea 11.6 mM/L, creatinine 157 mM/L, creatine kinase (CK) 7,736 U/L (normal <150 U/L) and troponin 9.44 g/L (normal <0.2 g/L). His ethanol level was negative. His EKG was normal sinus rhythm with a right bundle branch block, without ischemic features. A chest X-ray and contrast enhanced computed tomography scan of the chest revealed a hiatus hernia, a left lower lobe consolidation, and no evidence of pulmonary embolism (Figure 1).Acute rhabdomyolysis was diagnosed and the patient received four liters of fluid over the ensuing 24 hours. During volume resuscitation he developed pulmonary crackles, his JVP increased to 5 cm above the sternal angle and his O 2 saturation decreased to 90% on room air. He was placed on supplemen...

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Section: Discussionmentioning

confidence: 99%

Post-Vaccination Myositis and Myocarditis in a Previously Healthy Male

Cheng¹,

Kozoriz²,

Ahmadi³

et al. 2015

Intern Med

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“…1 Also called 'witch's milk', it results from the precipitous drop in maternal hormones after delivery and high levels of fetal and newborn prolactin. 2 Unilateral or bilateral bloody nipple discharge (BND) is rare in childhood, and it has only been described in single cases in published reports. This is a very distressing condition to both parents and physicians because of its association with breast carcinoma in adulthood.…”

Section: Bloody Nipple Discharge In a Breastfeeding Boymentioning

confidence: 99%

“…[1][2][3] In addition, three paediatric cases of recurrent FM (9-year-old boy, 4 12-year-old boy 5 and 15-year-old boy 1 ) have been reported thus far. We describe here a 5-monthold girl who developed recurrent FM originating from the left temporal muscle.…”

mentioning

confidence: 99%

“…Several treatment options have been attempted, including non-steroidal anti-inflammatory drugs, methotrexate and methylprednisolone; however, no consistent results have been obtained thus far. 2,4 The aetiology of recurrent FM remains unknown. Manganelli et al 2 reported a case of a 22-year-old man who developed bilateral recurrent FM of the gastrocnemius muscles 3 weeks after receiving BCG vaccination.…”

mentioning

confidence: 99%

“…2,4 The aetiology of recurrent FM remains unknown. Manganelli et al 2 reported a case of a 22-year-old man who developed bilateral recurrent FM of the gastrocnemius muscles 3 weeks after receiving BCG vaccination. Our patient was administered BCG vaccination 2 months prior to the swelling of the left temporal muscle.…”

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confidence: 99%

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Letter to the Editor

Nakane¹,

Nakamura²,

Hata³

et al. 2010

J Paediatrics Child Health

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Focal myositis (FM) is a benign inflammatory pseudo-tumour of skeletal muscle. Focal enlargement is usually self-limiting without recurrence. Very few recurrent FM cases have been reported in adults. [1][2][3] In addition, three paediatric cases of recurrent FM (9-year-old boy, 4 12-year-old boy 5 and 15-year-old boy 1 ) have been reported thus far. We describe here a 5-monthold girl who developed recurrent FM originating from the left temporal muscle. To our knowledge, this is the first report of recurrent FM in an infant.The patient was born to healthy parents via Caesarean section at the gestational age of 38 weeks and 5 days because of fetal distress. The patient had no siblings. At the age of 3 months, she received a Bacille de Calmette et Guerin (BCG) vaccination. At the age of 5 months, the mother observed a painful swelling in the left temporal region of the infant. There was no previous history of trauma. Physical examination revealed a firm mass measuring 5 cm in diameter over the left temporal bone. No neurological deficit was observed. Otitis media was excluded. Blood chemistry showed a marked elevation in creatine kinase (CK) (633 IU/mL, reference value 13-33) and a mild increase in aspartate aminotransferase (AST) (48 IU/mL, reference value 6-27). C-reactive protein was slightly elevated. Anti-nuclear antibody, angiotensin-converting enzyme and anti-Jo-1 antibody levels were within their normal ranges. Complete blood count analysis did not reveal significant changes. Eosinophilia was not seen. Contrast-enhanced T1-weighted magnetic resonance imaging (MRI) with fat suppression showed an enlarged muscle of the left temporal region and increased signal intensity within the left temporal muscle (Fig. 1). The left temporal swelling resolved after 1 week of treatment with a cephem antibiotic, Cefazolin (Astellas Pharma Inc., Tokyo, Japan).

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Myositis and Vaccines

Rodríguez‐Pintó

Shoenfeld

2015

Vaccines and Autoimmunity

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Bilateral recurrent focal myositis of gastrocnemius muscles after BCG vaccination

Cited by 17 publications

References 11 publications

Post-Vaccination Myositis and Myocarditis in a Previously Healthy Male

Post-Vaccination Myositis and Myocarditis in a Previously Healthy Male

Letter to the Editor

Myositis and Vaccines

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