Gastrocnemius Myositis in a Patient with Inflammatory Bowel Disease

Hall, M.J.; Thomas, W. E. G.; Cooper, B. T.

doi:10.1159/000199251

Cited by 24 publications

(11 citation statements)

References 9 publications

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“…Published case reports of gastrocnemius myalgia linked to CD have shown similar prevalence in both genders, with patient age ranging from 19 to 50 years. Muscle histology showed granulomatous myositis in 2 cases [4, 5], nonspecific myositis in 4 cases [6, 7, 8, 11], and vasculitis in 3 other cases [9, 10]. …”

Section: Discussionmentioning

confidence: 99%

“…Only 1 case presented with high c-ANCA titers [11]. The main features of reported cases of gastrocnemius myalgia associated with CD are summarized in Table 1.…”

Section: Discussionmentioning

confidence: 99%

“…The main features of reported cases of gastrocnemius myalgia associated with CD are summarized in Table 1. All cases of calf-limited myalgia reported in the literature responded to prednisolone [4, 6, 7, 8, 9, 10, 11, 12] except 1 [5]. In 2 young females, a combination treatment of prednisolone plus azathioprine or cyclophosphamide [10] seemed to be effective.…”

Section: Discussionmentioning

confidence: 99%

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Isolated Bilateral Gastrocnemius Myositis in Crohn Disease Successfully Treated with Adalimumab

Prampero

Marino

Toso

et al. 2016

Case Rep Gastroenterol

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Extraintestinal manifestations are common in inflammatory bowel disease; however, muscular involvement in Crohn disease is rarely reported. We present a case of a 26-year-old male with ileocolonic Crohn disease who developed sudden tenderness in both calves. Doppler ultrasound was negative for deep vein thrombosis. Magnetic resonance imaging of the gastrocnemius muscle showed high intensity signal in the muscle fibers, and muscle biopsy demonstrated nonspecific lymphocytic myositis. Other relevant laboratory results included normal antineutrophil cytoplasmic antibodies and creatine kinase as well as elevated C-reactive protein, erythrocyte sedimentation rate, and anti-Saccharomyces cerevisiae IgG titer. The patient was in clinical remission, being treated with azathioprine 2.5 mg/kg. Prednisone 60 mg/day was initiated with rapid resolution of calf tenderness; however, tenderness soon returned when the dose was tapered to 10 mg/day. Subsequently, prednisone and azathioprine were discontinued, and adalimumab was started at standard induction and maintenance doses. The patient’s symptoms resolved shortly after the first induction dose. A repeat magnetic resonance imaging of the calves – 3 months after starting adalimumab – showed complete resolution of muscle inflammation. To our knowledge, this is the first case of gastrocnemius myositis – a rare extraintestinal manifestation of Crohn disease – successfully treated with anti-tumor necrosis factor agents.

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Section: Discussionmentioning

confidence: 99%

“…Only 1 case presented with high c-ANCA titers [11]. The main features of reported cases of gastrocnemius myalgia associated with CD are summarized in Table 1.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Isolated Bilateral Gastrocnemius Myositis in Crohn Disease Successfully Treated with Adalimumab

Prampero

Marino

Toso

et al. 2016

Case Rep Gastroenterol

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“…17 However, in most of the earlier cases of inflammatory myopathy associated with Crohn's disease, patients were treated with steroids or other immunosuppressive therapy. 3,4,[7][8][9]11,13,14 Given that the myopathy in Crohn's disease is attributable to inflammation of the bowel structures, treatment targeted to the diseased bowel should be considered as a potential therapy for both diseases. Al-Kawas 1 reported a case of myositis in a Crohn's patient who showed improvement in muscle but not gut symptoms with sulfasalazine.…”

Section: Discussionmentioning

confidence: 99%

Immune‐mediated myositis in Crohn's disease

et al. 2008

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We report a patient with uncontrolled Crohn's disease who presented with progressive weakness of proximal muscles and a marked elevation of serum creatine kinase. Muscle biopsy from the left deltoid exhibited myositic changes with inflammatory infiltrates in the perimysium, endomysium, and perivascular locations. Most were stained as CD68-positive macrophages, whereas some were CD4- and CD8-positive T lymphocytes. Due to uncontrolled bowel inflammation, several fistulae were found in the descending colon, and partial colectomy was performed. An examination of the resected colon exhibited inflammation of the bowel structure surrounded mainly by CD68-positive macrophages. The histopathological findings of the descending colon were analogous to those of the muscle. After an increased dose of mesalazine and partial colectomy, her muscle symptoms improved. These findings suggest that the myositis in Crohn's disease is immune-mediated and that treatment of bowel inflammation should be emphasized as opposed to steroid or other immunosuppressive therapy.

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“…Few cases have reported an association of polymyositis with CD, although the occurrence of polymyositis, alopecia universalis, and primary sclerosing cholangitis was observed in a male CD patient in Germany [8], and Hall documented a case of focal myositis involving the left gastrocnemius muscle [9]. The timing of the onset of myositis has been shown to vary widely among patients with IBD [10-12].…”

Section: Introductionmentioning

confidence: 99%

The concurrent association of inflammatory polymyositis and Crohn’s ileo-colitis in a Sri Lankan man: a case report of a rare association and literature review

et al. 2014

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BackgroundCrohn’s disease is a relapsing, systemic inflammatory disease affecting the gastrointestinal tract with associated extraintestinal manifestations and immune disorders. Among the few cases reported, the association of Crohn’s disease with polymyositis varies in its complexity and severity. We report here the first known case of inflammatory polymyositis leading to rhabdomyolysis in a male patient diagnosed with Crohn’s ileocolitis.Case presentationA 42-year-old previously healthy man presented with acute polymyositis leading to rhabdomyolysis. The acute nature of the illness raised the suspicion of an infective, toxic, or metabolic insult, which was excluded during further investigations. Prolonged low-grade fever and raised inflammatory markers led to the suspicion of inflammatory polymyositis, which was confirmed by electromyography and muscle histology. In the absence of an infective cause, the concurrent association of prolonged diarrhea containing blood and mucous after recovery from an acute phase of myositis proved a diagnostic challenge. Ileocolonoscopy findings of extensive aphthous ulceration with skip lesions extending to the terminal ileum, and histology showing polymorph infiltration of the lamina propria, transmural involvement, and micro abscess formation was suggestive of Crohn’s disease. Sensory motor axonal peripheral neuropathy, which is another rare association of inflammatory bowel disease, was also present.ConclusionAn unrecognized genetic predisposition or altered gut permeability causing disruption of the gut immune barrier triggering an immune response against skeletal muscles may have contributed to this unique association. Both polymyositis and Crohn’s ileocolitis responded well to corticosteroids and azathioprine, which is supportive of their immune pathogenesis. Myositis can be considered to be a rare extraintestinal manifestation of Crohn’s disease and can be used in the differential diagnosis of corticosteroid or hypokalemia-induced myopathy in Crohn’s disease.

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Gastrocnemius Myositis in a Patient with Inflammatory Bowel Disease

Cited by 24 publications

References 9 publications

Isolated Bilateral Gastrocnemius Myositis in Crohn Disease Successfully Treated with Adalimumab

Isolated Bilateral Gastrocnemius Myositis in Crohn Disease Successfully Treated with Adalimumab

Immune‐mediated myositis in Crohn's disease

The concurrent association of inflammatory polymyositis and Crohn’s ileo-colitis in a Sri Lankan man: a case report of a rare association and literature review

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