Chronic eosinophilic perimyositis with persistent myalgias

Abstract

A 43-year-old man with an 8-year history of hypereosinophilia was evaluated for persistent muscle pain. Methotrexate and corticosteroids were ineffective. Examination, limited by pain even with passive motion, showed only mild weakness. Electromyography and muscle enzymes were normal. A needle muscle biopsy specimen revealed eosinophilic perimyositis. This case illustrates that the diagnosis of eosinophilic perimyositis requires histopathological evaluation, which should be pursued in patients with eosinophilia and persistent myalgia despite normal electromyography and muscle enzymes.

Eosinophilia-associated muscle disorders: an immunohistological study with tissue localisation of major basic protein in distinct clinicopathological forms

“…An association of lower eosinophil density with “minimal change” eosinophilic oesophagitis has been suggested 27. It is noteworthy that patients with recurrent eosinophilia often complain of persistent muscle pain/fatigability, even with normal electromyography, and single reports have described chronic fasciitis/perimyositis with slow onset and variable myopathic clinical expression 28 29. In view of this, the clinicopathological differences between our cases III–VII and E-PM suggest the occurrence of a spectrum of less aggressive idiopathic eosinophilic myopathies also, with insidious onset, chronic course and intermediate density of tissue eosinophils that might be underestimated by conventional histology.…”

High aldolase with normal creatine kinase in serum predicts a myopathy with perimysial pathology

“…The prominent involvement of connective tissue with damage to, and acid phosphatase positive cellularity in, the perimysium, without involvement of capillaries, was similar to the MPP found in anti-Jo-1 myopathy syndromes (table 3). 8 Selective perimysial pathology has also been reported in other syndromes involving connective tissue such as fasciitis2 and perimyositis,10 especially syndromes associated with eosinophilia. Eosinophilia was present in 25% of our patients.…”

Eosinophilia, myositis, and myasthenia gravis associated with a thymoma

“…The original report of eosinophilic myositis by Layzer et al10 described evidence of eosinophilia on muscle biopsy. However, subsequent reports have emphasized that a spectrum of inflammatory connective muscle tissue changes may be associated with blood eosinophilia ranging from fasciitis to perimyositis, and eosinophilia may be absent from adjacent muscle tissue 4, 25…”