Generalized myositis mimicking
polymyositis associated with chronic
active Epstein-Barr virus infection

Uchiyama, Tomoyuki; Arai, Kimito; Yamamoto-Tabata, Takako; Hirai, Kanji; Kishimoto, Kazuo; Nakamura, Yoshiko; Hattori, Takamichi

doi:10.1007/s00415-005-0679-1

Cited by 27 publications

(33 citation statements)

References 33 publications

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“…A pathogenetic correlation between cancers of the pharynx, especially NPC, and DM has been proposed. NPC is endemic to southeastern Asia and is related to the chronic active infection of Epstein-Barr virus [17-19]. Three cases of chronic active Epstein-Barr virus infection-induced generalized myositis have been reported [19].…”

Section: Discussionmentioning

confidence: 99%

Cancer risks of dermatomyositis and polymyositis: a nationwide cohort study in Taiwan

et al. 2010

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IntroductionThe association of idiopathic inflammatory myositis (IIM) and malignancies has been reported, but rarely in Asian countries. Our aim was to investigate the risk of cancer among IIM patients without a prior history of malignancies, in Taiwan.MethodsWe conducted a nationwide cohort study of 1,012 patients with dermatomyositis (DM) and 643 patients with polymyositis (PM), but without prior history of malignancies, utilizing the National Health Insurance Database from 1997 to 2007. Standardized incidence ratios (SIRs) of cancers were analyzed.ResultsA total of 95 cancers (9.4%) in DM and 33 cancers (4.4%) in PM were identified. Overall cancer risk was significantly elevated in DM patients (SIR = 5.11, 95% confidence interval [CI] = 5.01 to 5.22) and PM patients (SIR = 2.15, 95% CI = 2.08 to 2.22). Most cancers were detected in the first year of observation. The risk of cancer decreased with observation time, yet remained elevated compared with the general population in both study groups after 5 years of follow-up. DM was associated with sustained elevated risk of cancers in every age group, whereas the risk of cancer in PM was highest in younger patients and decreased with age. DM patients were at the greatest risk of cancers of the nasopharynx, lungs and hematopoietic malignancies.ConclusionsPatients with IIM are at increased risk for cancer and should receive age-appropriate and gender-appropriate malignancy evaluations, with additional assessment for nasopharyngeal, lung and hematologic malignancy following diagnosis, and with continued vigilance for development of cancers in follow-up.

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Section: Discussionmentioning

confidence: 99%

Cancer risks of dermatomyositis and polymyositis: a nationwide cohort study in Taiwan

et al. 2010

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“…2, and whose onsets were clear after 20 years of age. Eighteen reported patients were selected as shown in Table 2 [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

Section: Analysis Of Reported Casesmentioning

confidence: 99%

Clinical features of adult-onset chronic active Epstein–Barr virus infection: a retrospective analysis

et al. 2011

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We performed a retrospective analysis of patients with adult-onset chronic active Epstein-Barr virus infection (CAEBV). First, we analyzed five patients (aged 28-72) diagnosed at our hospitals with EBV-infected clonally proliferating T cells. Four patients were administered cyclophosphamide/doxorubicin/vincristine/prednisone (CHOP) chemotherapy, but no remarkable decrease of viral load was observed in three of the patients. The other patient died 19 days after initiation of CHOP treatment due to disease progression. Addition of high-dose cytarabine to the regimens of two of the patients was discontinued shortly after administration, due to the development of grade 4 pericardial effusion. Together, these regimens may be insufficient for treating adult-onset CAEBV. We next reviewed 23 adult-onset CAEBV patients, adding 18 previously reported patients to the five patients described in the present study. T cells were frequently infected (87%), whereas NK- and T-cell types are known to be almost equally prevalent in childhood-onset cases. The time duration from the onset of disease to initiation of treatment averaged 20 months. Reports showed that 12 patients died; seven patients died at an average of 8 months after initiation of treatment. Patients' disease courses seemed to be rapidly progressive and more aggressive than those of childhood-onset cases. More cases must be studied to clarify clinical features and establish an optimal treatment strategy.

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“…Other viruses linked to myositis include herpetic viruses, such as cytomegalovirus (139,160), Epstein-Barr virus (178,203,234), herpes simplex virus (203), and varicella-zoster virus (13). Dengue virus has also been associated with myalgias and myositis; a recent report described a severe case of myositis due to dengue virus (77).…”

Section: Other Virusesmentioning

confidence: 99%

Bacterial, Fungal, Parasitic, and Viral Myositis

2008

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SUMMARY Infectious myositis may be caused by a broad range of bacterial, fungal, parasitic, and viral agents. Infectious myositis is overall uncommon given the relative resistance of the musculature to infection. For example, inciting events, including trauma, surgery, or the presence of foreign bodies or devitalized tissue, are often present in cases of bacterial myositis. Bacterial causes are categorized by clinical presentation, anatomic location, and causative organisms into the categories of pyomyositis, psoas abscess, Staphylococcus aureus myositis, group A streptococcal necrotizing myositis, group B streptococcal myositis, clostridial gas gangrene, and nonclostridial myositis. Fungal myositis is rare and usually occurs among immunocompromised hosts. Parasitic myositis is most commonly a result of trichinosis or cystericercosis, but other protozoa or helminths may be involved. A parasitic cause of myositis is suggested by the travel history and presence of eosinophilia. Viruses may cause diffuse muscle involvement with clinical manifestations, such as benign acute myositis (most commonly due to influenza virus), pleurodynia (coxsackievirus B), acute rhabdomyolysis, or an immune-mediated polymyositis. The diagnosis of myositis is suggested by the clinical picture and radiologic imaging, and the etiologic agent is confirmed by microbiologic or serologic testing. Therapy is based on the clinical presentation and the underlying pathogen.

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Generalized myositis mimicking polymyositis associated with chronic active Epstein-Barr virus infection

Cited by 27 publications

References 33 publications

Cancer risks of dermatomyositis and polymyositis: a nationwide cohort study in Taiwan

Cancer risks of dermatomyositis and polymyositis: a nationwide cohort study in Taiwan

Clinical features of adult-onset chronic active Epstein–Barr virus infection: a retrospective analysis

Bacterial, Fungal, Parasitic, and Viral Myositis

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