Unnecessary diagnostic investigations in benign acute childhood myositis: a case series report

Abstract

Benign acute childhood myositis (BACM) is a rare, acute, self-limiting muscle disorder, mainly affecting school-aged boys, with an excellent prognosis, requiring no therapeutic intervention. We report a series of seven previously healthy school-aged children with clinical and laboratory findings suggesting BACM where no specific diagnostic investigations were performed. All of the children were hospitalized without any specific therapeutic intervention and were discharged after two or three days free of symptoms, residual impairment or other complication. This report emphasizes that the correct diagnosis of BACM, by considering the characteristic clinical and laboratory findings of this syndrome and by recognizing more severe pathological conditions, which must be excluded from the diagnosis, can prevent unnecessary diagnostic investigations and reassure both parents and patients of the excellent prognosis.

Benign acute childhood myositis: an alarming condition with an excellent prognosis!

“…Benign acute childhood myositis is a rare disorder and continues to lead physicians into unnecessary workup when they are unfamiliar with its presentation [1][2][3][4][5]. Most commonly occur after influenza B and occasionally influenza A infection, but parainfluenza, adenovirus, herpes simplex, Epstein-Barr, Coxsackie, rotavirus, and M pneumoniae have also been implicated [1][2][3][5][6][7][8][9][10], as found in our study.…”

“…As evidenced, key elements in the diagnosis are a preceding upper respiratory infection followed by the acute onset of typical myositis clinical findings, predominantly affecting gastrocnemius-soleus muscles. Further clinical features include school-aged boys and late winter-early spring predominance, elevated CK, and aminotransferase levels (especially AST) [1][2][3][4][5][6][7][8][9][10]. Transient hematological abnormalities (mild leukopenia, neutropenia, and thrombocytopenia) are also seen [1,3,[8][9][10].…”

“…If different etiologic agents were behind these episodes, it was not possible to assess. Treatment is supportive, and antivirals are unlikely to be beneficial [2][3][4][5]. The hallmark of BACM is its spontaneous and rapid clinical resolution within 1 week [1][2][3][4][5].…”

Benign acute myositis in an adult patient

“…A muscle biopsy was thus performed whereas it is not useful for the diagnosis of benign acute childhood myositis 5. However, we noted after the recovery that our patient had the typical symptoms and course of benign acute childhood myositis especially the calf oedema and myositis of leg muscles.…”

“…The prognosis is excellent as patients present with spontaneous normalisation of symptoms and serum creatine kinase (CK) levels 3 4. It is well known by paediatricians that invasive investigations are not useful 5. This entity is often considered as affecting exclusively the children and physicians may be unaware that adult cases may also occur.…”