Severe Rhabdomyolysis without Systemic Involvement: A Rare Case of Idiopathic Eosinophilic Polymyositis

Abstract

Introduction. Eosinophilic polymyositis (EPM) is a rare cause of rhabdomyolysis characterized by eosinophilic infiltrates in the muscle. We describe the case of a young patient with eosinophilic polymyositis causing isolated severe rhabdomyolysis without systemic involvement. Case Presentation. A 22-year-old Haitian female with no past medical history presented with progressive generalized muscle aches without precipitating factors. Examination of the extremities revealed diffuse muscle tenderness. Laboratory findings demonstrated peripheral eosinophilia and high creatinine phosphokinase (CPK) and transaminase levels. Workup for the common causes of rhabdomyolysis were negative. Her CPK continued to rise to greater than 100,000 units/L so a muscle biopsy was performed which showed widespread eosinophilic infiltrate consistent with eosinophilic polymyositis. She was started on high dose systemic corticosteroids with improvement of her symptoms, eosinophilia, and CPK level. Discussion. This case illustrates a systematic workup of rhabdomyolysis in the presence of peripheral eosinophilia. Many differential diagnoses must be considered before establishing a diagnosis of idiopathic eosinophilic polymyositis. To our knowledge, our case of eosinophilic polymyositis is unique as it presented with severe rhabdomyolysis without another organ involvement. Clinicians should maintain a high index of suspicion for this physically debilitating disease to aid in prompt diagnosis.

Polymyositis Presenting With Nontraumatic Rhabdomyolysis and Dysphagia: A Case Report

“…This report illustrates the need to keep IIMs as part of the differential diagnosis in rhabdomyolysis. [23][24][25][26][27][28] Normally, the intracellular gradient of Sodium (Na + ) and Calcium (Ca 2 +) ions is maintained at low concentrations through the action of Na/K-ATPase pumps, as well as ion exchangers and transporters. Regardless of whether the initial insult is traumatic, genetic, biochemical, or inflammatory, the pathomechanism of rhabdomyolysis converges: a disruption of the cell membrane leads to an influx of sodium and calcium ions into the cytoplasm, disrupting energy production and activating calcium-dependent proteases and phospholipases, which further damage myocytes and disrupt membrane integrity.…”

A Curious Case of Proximal Muscle Weakness with Eosinophilic Polymyositis

“…EM is a rare group of heterogeneous conditions that are characterized by the presence of peripheral and/or muscle eosinophilia. There are three major subsets of EM: focal eosinophilic myositis, eosinophilic polymyositis, and eosinophilic perimyositis [ 1 , 2 ]. The latter is typically associated with eosinophilic inflammatory infiltrates in the superficial and deep fascia in addition to muscle.…”

“…Idiopathic eosinophilic polymyositis is a rare form of inflammatory myopathy. Diagnosis evaluation to exclude systemic causes of eosinophilia is required in these patients [ 1 , 2 ]. The prognosis of idiopathic eosinophilic polymyositis is good.…”

“…Eosinophilic myopathies (EM) comprise a clinically and pathologically heterogeneous group of rare diseases that include three main subtypes: focal eosinophilic myositis, eosinophilic polymyositis, and eosinophilic perimyositis. We present a case of eosinophilic polymyositis, a rare disease with few cases reported in the literature [ 1 , 2 ].…”

Idiopathic eosinophilic myositis: a systematic literature review

“…DEM [1,9,[14][15][16][17][18][19]25,29,[56][57][58][59][60][61][62][63][64][65][66][67]; EP [5,9,[19][20][21]26,32,46,[68][69][70].…”