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PubMed1995

Disseminated histoplasmosis presenting as myositis and fasciitis in a patient with dermatomyositis.

A 54-year-old man with dermatomyositis initially responsive to corticosteroids and methotrexate developed severe myalgias, increasing weakness, and fevers. Laboratory studies were suggestive of disseminated histoplasmosis, and muscle biopsy revealed myositis, fasciitis, and yeast in the perimysial connective tissue. Histoplasma capsulatum was cultured from skeletal muscle. Despite antifungal therapy, necrotizing fasciitis progressed to gluteal abscess formation. Disseminated histoplasmosis may present atypically in immunocompromised hosts as fasciitis and myositis. Patients with dermatomyositis could be particularly vulnerable to soft tissue invasion by fungi due to their underlying microangiopathy.

Abscess↗
PubMed2005

Myositis complicating viridans streptococcal sepsis in childhood leukemia.

Hematogenous focal infections are a rare complication of bacteremia or sepsis caused by viridans-group streptococci. We describe two patients with acute leukemia who developed myositis during alpha-hemolytic streptococcal bacteremia. Children complaining of severe muscle pain associated with viridans streptococcal infections should be carefully evaluated for the presence of focal pyogenic complications and rhabdomyolysis. The severity of infectious myositis is highly variable, depending on the etiologic organism and host immunity, making individualized treatment the most effective approach.

Adolescent↗
PubMed1998

Interleukin 6, but not ciliary neurotrophic factor or leukaemia inhibitory factor, is responsible for the acute phase response to turpentine-induced myositis.

The acute phase response to inflammation is mediated in part by the endogenous production of pro-inflammatory cytokines. Interleukin 6 (IL-6) and members of its superfamily, including ciliary neurotrophic factor (CNTF) and leukaemia inhibitory factor (LIF) have been implicated as primary mediators of the hepatic acute phase response. In the present report, mice suffering a turpentine-induced myositis were passively immunized with antibodies against either IL-6, CNTF or LIF. Passive immunization against IL-6 attenuated the anorexia and completely prevented the hypoalbuminaemia, and increases in the serum concentration of the acute phase reactants, amyloid P, amyloid A and seromucoid. In contrast, passive immunization against either CNTF or LIF failed to modulate the anorexia, weight loss or hepatic acute phase protein responses. The findings suggest that IL-6, but not other members of its superfamily, is primarily responsible for the hepatic acute phase response, and contributes to the anorexia, associated with turpentine-induced myositis.

Acute-Phase Reaction↗
PubMed1994

Induction of recurring myositis ossificans by intrathymic injection of 3-methylcholanthrene-treated cells in rats.

Studies were performed to ascertain the effects of transplantation of thymic cells exposed in vivo to 3-methylcholanthrene (3-MC) on the induction of malignancies in Copenhagen rats. Three recipient rats unexpectedly developed tumors which bore histological resemblance to myositis ossificans of humans. Specifically, histology revealed areas of peripheral ossification with the appearance of zones of primitive osteoid with a central cellular area. Other areas of the lesions were less well organized into characteristic zones or were more or less heterogeneous. The primary, as well as recurring, lesions appeared in the axilla and were well circumscribed, 24-68 g in weight and 2-7 cm in diameter. Flow cytometric analyses of DNA content indicated that these tumors contained cells with abnormal DNA characteristics as well as proliferating cells. Coupled with the observation that after excision these tumors recurred, the data suggest that these myositis ossificans lesions were malignancies.

Animals↗
PubMed1994

Expression of growth associated protein 43 and neural cell adhesion molecule in congenital fibre type disproportion with interstitial myositis.

We report on the expression of growth associated protein (GAP)43 and neural cell adhesion molecule (NCAM) in congenital fibre type disproportion (CFTD) with myopathological additional signs of interstitial myositis. We assume that sarcolemmal GAP43 in developmental disordered myocytes plays a role in maintenance of growth morphology. In muscular dystrophy light microscopical evaluation reveals no GAP43 immunoreactivity in regenerating fibres. The expression of GAP43 seems to be a characteristic feature of CFTD. The expression of NCAM, particularly in the sarcolemma of small muscle fibres of CFTD, indicates a functional state of permanent partial denervation. Whether the steroid-responsive interstitial myositis is pathogenetically related to CFTD or a coincidental inflammation is not known. Because of the clinical and myopathological data the differential diagnosis of Emery-Dreifuss muscular dystrophy is considered.

Adult↗
PubMed1990

Acute toxoplasma myositis: an immunohistochemical and ultrastructural study.

The occurrence is reported of acute myositis in a man with meningoencephalitis due to toxoplasmosis. The ultrastructure and immunohistochemistry of a muscle biopsy of the patient were investigated. Toxoplasma organisms were not found in the muscle biopsy. The perivascular inflammatory cells in the muscle were mainly CD4+ T cells and the inflammatory cells in and around the muscle fibres were chiefly macrophages. Expression of major histocompatibility complex class I and II antigens was observed in the infiltrating cells and endothelial cells of the blood vessels. A small proportion of the infiltrating cells expressed interferon-gamma. A possible role of the immune mechanism in the evolution of myositis is discussed.

Acute Disease↗
PubMed1976

[On myositis ossificans localisata and its operative treatment (author's transl)].

We observed 52 patients with myositis ossificans localisata partly of a traumatic, neurogenic or morbid (inflammable) origin. The fact that preferably young men are concerned in cases of traumatic and neurogenic myositis ossificans localisata is certainly not only caused by their increased exposition to trauma, but also by disposition. For indication and operative treatment it is necessary to classify as well as radiologically III different stages of development as respective groups of muscles. In posttraumatic and neurogenic cases relapses post operationem may probably be avoided in case, there is a radiological stage III (total development of muscle ossification).

Adolescent↗
PubMed1975

Proliferative myositis. A case report with fine structural analysis.

A report is given on a case of proliferative myositis in a 75 year old woman. By fine structural analysis it can be shown, that the characteristic giant cells in proliferative myositis are mesenchymal cells with an intensive protein metabolism. They can be compared to fibroblasts; for a myogenic origin of these cells we found noevidence. Furthermore, various stages in the development and function of the proliferating cells were observed, by which the course of the disease can be expalined.

Aged↗
PubMed1986

Meningopolyneuritis Bannwarth with focal nodular myositis. A new aspect in Lyme borreliosis.

A patient with serologically confirmed infection by Borrelia burgdorferi presenting with painful paresis and atrophy of the proximal muscles of both upper extremities and bilateral facial paresis is described. Electromyography showed a neurogenic and myopathic pattern, and creatine kinase was raised. Muscle biopsy revealed the typical signs of focal myositis. Treatment with i.v. penicillin led to dramatic clinical and serological improvement. Muscle biopsy was repeated 2 months later; neurogenic changes were still present, but no inflammatory signs could be seen anymore. Thus, the presented case may be the first reported of meningopolyneuritis accompanied by focal nodular myositis, in the second stage of Lyme borreliosis.

Biopsy↗
PubMed1992

Localized nodular myositis. A paraneoplastic phenomenon.

Localized nodular myositis was recognized in an elderly man six months prior to the diagnosis of Hodgkin's disease. Meticulous search of the muscle specimen failed to disclose tumorous involvement. The possible paraneoplastic nature of localized nodular myositis in this patient is discussed.

Aged↗
PubMed2000

Oral pulsed high-dose dexamethasone for myositis.

To study the short-term effect of oral pulsed high-dose dexamethasone for myositis we treated eight newly diagnosed patients with three 28-day cycles of oral dexamethasone. Primary outcome measures were muscle strength, pain, and serum creatine kinase activity. Six patients responded. Side effects were mild. At follow-up five responders were still in remission, without medication. Pulsed high-dose dexamethasone seems beneficial in myositis. A larger, prednisone-controlled trial is justified to analyze long-term efficacy.

Administration, Oral↗
PubMed2002

[Focal myositis--an indication for surgery? A case report].

This case report describes focal myositis, a rare inflammatory pseudotumorous disease previously not mentioned in the surgical literature. Most often a single muscle of the upper or lower extremity is affected. Usually the diagnostic process and treatment require a long time. We present a useful diagnostic cascade and a surgical therapy, which allows the histological differentiation between malignant and inflammatory disease. Even after partial resection of the tumor, the prognosis of focal myositis is excellent.

Diagnosis, Differential↗
PubMed1999

Abdominal-wall myositis secondary to intra-arterial chemotherapy for femoral osteosarcoma.

With the increasing application of intra-arterial chemotherapy (IAC), new side-effects are encountered. We describe two children with proximal femoral osteosarcoma who developed focal myositis of the abdominal wall musculature after IAC. In both cases, myositis presented as abdominal pain and mimicked acute abdomen. US demonstrated asymmetrical thickening of abdominal-wall musculature in the right lower abdomen. This diagnosis should be considered when evaluating the patient with unexplained abdominal pain and a history of IAC.

Abdominal Muscles↗
PubMed2002

Focal myositis of the thigh: unusual MR pattern.

Focal myositis is a commonly referenced, infrequently reported and poorly documented benign inflammatory pseudotumor which may be misdiagnosed clinically as a malignant tumor. We report the clinicopathologic features and magnetic resonance imaging findings in a case of focal myositis in the thigh of a 55-year-old woman. A different radiologic presentation of this disorder is described. The gross appearance of the lesion, previously undescribed, appears to be rather specific for such a pseudoneoplastic disorder, and correlates very well with the magnetic resonance imaging features.

Female↗
PubMed2001

Extraskeletal osteosarcoma arising in myositis ossificans.

A 53-year-old woman had extraskeletal osteosarcoma that developed from a soft tissue bony mass present on the volar aspect of the left wrist for 4 years. Initially, the bony mass was soft and movable, but during the first year it became hard and fixed. The patient had no history of trauma. Because the lesion did not grow or cause any symptoms, the patient did not come to the hospital until 4 years after she first noticed the lesion. Radiologically, the bony mass had features characteristic of mature myositis ossificans, showing "eggshell" ossification. A nonmineralized soft tissue mass occurred between the surface of the radius and the bony shell. Histologically, a high-grade osteosarcoma was present between the surface of the radius and the well-differentiated bone tissue, which included fatty and hematopoietic marrow. All the findings indicated that our patient had an extremely rare case of malignant transformation of myositis ossificans.

Female↗
PubMed1999

Proliferative myositis in a child.

A case of proliferative myositis in the lumbar paraspinal muscles in a 14-year-old boy is presented. Imaging investigations including plain radiograph, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), bone scan and positron emission tomography (PET) were suggestive of an inflammatory process such as myositis ossificans. The diagnosis was made by incisional biopsy. More pronounced edema, more muscle fiber necrosis and a higher cellularity were found compared to adult cases. The karyotype of the lesion was normal. Clinically, the mass disappeared spontaneously. After 24 months, asymptomatic bridging ossification between the third and fourth lumbar vertebrae was noted.

Adolescent↗
PubMed2004

Left gluteal focal myositis in a patient with signet ring adenocarcinoma of the stomach: not a paraneoplastic phenomenon.

Focal myositis, the much rarer clinical and pathological variant of polymyositis, is generally a benign inflammatory pseudotumor of skeletal muscle Thus far, only three cases have been reported in association with a neoplasm. We now describe a fourth case of localized gluteal myositis seen in a case of signet ring adenocarcinoma of the stomach occurring not as a paraneoplastic syndrome, as in the previously reported three cases, but as an immunoinflammatory response around metastatic cell foci in both the involved muscles and local lymphatics.

Adult↗
PubMed1998

Diagnosis of idiopathic myositis: value of 99mtechnetium pyrophosphate muscle scintigraphy and magnetic resonance imaging in targeted muscle biopsy.

Our objective was to study the value of 99mtechnetium-pyrophosphate (99mTc-PYP) muscle scintigraphy and magnetic resonance imaging (MRI) in detecting areas of likely muscle inflammation and in increasing the rate of positive muscle biopsies in patients with suspected myositis. The results showed that in 13 out of 13 patients with clinical and/or signs of inflammatory muscle disease, increased 99mTc-PYP uptake was demonstrated at different muscle sites 3 h after isotope injection. Subsequent MRI of symmetric muscle areas with enhanced 99mTc-PYP uptake revealed signal patterns suggesting inflammation in all cases. Biopsy of these targeted muscles demonstrated characteristic histopathologic signs of muscle inflammation in 9 out of 13 patients. Four of these 9 patients had clinically atypical disease or did not show elevated creatine phosphokinase levels. Seven of these 9 patients had not been pretreated with corticosteroids. In 4 patients only muscle fiber atrophy and/or necrosis without cellular infiltrations was seen. These 4 patients had received either high doses of corticosteroids or low doses over longer periods of time before muscle biopsy. In conclusion, the combination of 99mTc-PYP muscle scintigraphy and MRI demonstrated muscle areas with maximum inflammatory signal patterns. Targeting of muscles by MRI only will probably yield reliable results of muscle biopsy in cases of clinically and serologically characteristic myositis. 99mTc-PYP muscle scintigraphy may provide useful initial information about localization of inflamed muscle tissue, especially in atypical disease. Treatment with corticosteroids prior to histologic diagnosis may abolish inflammatory infiltrations in affected muscle tissue.

Adolescent↗