Infectious Myositis of the Jaw Presenting as Trismus of Unknown Origin

Kim, Hee-Young,Chung, Jin-Woo Korean Academy of Orofacial Pain and Oral Medicine 2020 Journal of Oral Medicine and Pain Vol.45 No.4

Infectious myositis, an infection of the skeletal muscles, is a rare condition and potentially life-threatening if not detected and treated in the early stages. This clinical entity may arise from various pathogens, such as bacteria, fungi, parasites, and viruses. A propagation of contiguous infection, penetrating trauma, vascular insufficiency, or hematogenous spreading of microorganisms can cause infectious myositis. Though several cases have been reported in large muscle groups in the lower extremities, there are only a few reports on infectious myositis of the masticatory muscles. We report three cases of infectious myositis presenting jaw pain and trismus. Unlike a common head and neck infection caused by the spreading of odontogenic origin, the early diagnosis of infectious myositis was difficult because no specific lesion suspected to be the infection source was observed in the physical examination and the plain radiographs. Advanced imaging modalities such as computed tomography and magnetic resonance imaging, and laboratory evaluation is useful for the early detection of infectious myositis.

A case of all-trans retinoic acid-induced myositis

( Jung Hoon Lee ),( Si Youg Kim ),( Hwi Joong Yoon ),( Kyung Sam Cho ),( Seon Gyeong Baek ),( Jae Heon Jeong ),( Tae Sung Park ) 대한내과학회 2011 대한내과학회 추계학술발표논문집 Vol.2011 No.1

ATRA (all-trans retinoic acid) has became the standard induction therapy for acute promylelocytic leukemia (APL). With the use of ATRA for acute promylelocytic leukemia (APL), the number of reported adverse reactions is increasing, including the most frequent and fatal being the retinoic acid syndrome (RAS). ATRA-induced myositis is rarely described in patients with APL and in response to the steroids is known to be good. We report a case of a middle age man with APL (microgranular variant type) who developed ATRA-induced myositis with hemorrahagic abscess characterized by unexplained fevers, leg swelling of bilateral calf areas, and a painful purpuric petechial rash during induction treatment. Magnetic resonance (MR) imaging showed low signal intensity suggesting the diagnosis of multifocal inflammatory or hemorrhagic nodular lesion in the right soleus, left gastrocnemius, and both tibial anterior muscles, multiple areas of increased signal intensity in the anterior musculature on both leg due to myositis. And the muscle biopsy revealed acute and chronic myositis. ATRA was discontinued on day 18 and prednisone 75 mg daily was commenced. In the successive days, swelling, heating sense and painful muscle involvement disappeared. But a repeat bone marrow biopsy on day 25 showed persistence of APL with PML-RARA rearrangement. The patient of refractory state died by aggravation of pneumonia. As far as we know, this is the first case of ATRA-induced myositis in a middle age man with acute promylelocytic leukemia (APL) of microgranular variant type in korea.

A Case of Neutrophilic Myositis

( Kwang-hoon Lee ),( Kang-min Han ),( Eo-jin Kim ) 대한류마티스학회 2017 대한류마티스학회지 Vol.24 No.3

Neutrophilic myositis is a very rare disease histologically characterized by neutrophil infiltration of muscle tissues. We report a case of a 47-year-old man who presented with acute onset of severe swelling and pain on his left shoulder with high fever. He was initially suspected of having cellulitis, but intravenous antibiotics did not improve his symptoms. Similar swelling and pain then developed on both calves. Investigations with magnetic resonance imaging of the lower legs and muscle biopsy led to a diagnosis of neutrophilic myositis. High dose glucocorticoid dramatically improved his symptoms within days. Clinicians need to be aware of this rare disease as a cause of acute febrile myositis mimicking infection. (J Rheum Dis 2017;24:161-164)

항결핵제 복용 중 발생한 호산구성 근염 1예

김현정,박정은,류영하,우대형,신경철,정진홍,이관호 영남대학교 의과대학 2010 Yeungnam University Journal of Medicine Vol.27 No.1

Eosinophilic myositis is a rare idiopathic inflammatory muscle disease, and the patients with this malady present with diverse signs and symptoms such as muscle swelling, tenderness, pain, weakness, cutaneous lesions and eosinophilia. The etiology and pathogenesis of eosinophilic myositis remain elusive. Several drugs may occasionally initiate an immune mediated inflammatory myopathy, including eosinophilic myositis. We report here on a case a 17-year-old female patient who had taken anti-tuberculosis medicine for tuberculosis pleurisy. She presented with many clinical manifestations, including fever, skin rash, proximal muscle weakness, dyspnea, dysphagia and hypereosinophilia. She was diagnosed with eosinophilic myositis by the pathologic study. The muscle weakness progressed despite of stopping the anti-tuberculosis medicine, but the myositis promptly improved following the administration of glucocorticoid. Although drug induced myopathies may be uncommon, if a patient presents with muscular symptoms, then physicians have to consider the possibility of drug induced myopathies.

혀에 발생한 증식성 근육염

박명진 ( Myeong Jin Park ),성기현 ( Gi Hyun Seong ),박민기 ( Minkee Park ),최미수 ( Mi Soo Choi ),홍승필 ( Seung Phil Hong ),박병철 ( Byung Cheol Park ),김명화 ( Myunghwa Kim ) 대한피부과학회 2019 대한피부과학회지 Vol.57 No.1

Proliferative myositis is a rare, benign, probably pseudosarcomatous fibroblastic proliferation that typically presents as a rapidly growing soft tissue mass. Its relative rarity, fast growth rate, and unique histopathologic findings may lead to misdiagnosis as a malignant lesion and unnecessary radical surgical excision. A 57-year-old female presented with a non-tender, well-defined, indurated, solitary, hard papule on the median sulcus of the tongue for 2 weeks. Histologic examination revealed numerous fibroblastic or myofibroblastic spindle cells and large ganglion-like cells infiltrating between and around the muscle fascicles. Immunohistochemical staining showed positivity for vimentin, smooth muscle actin, and CD68 and negativity for S-100. Based on these characteristic clinical findings and histopathologic features, the patient was diagnosed with proliferative myositis. Here, we report a rare case of proliferative myositis on the tongue and recommend considering proliferative myositis in the differential diagnosis when a physician encounters a rapidly grown soft tissue mass. (Korean J Dermatol 2019;57(1):28∼31)

[P410] A case of proliferative myositis developed on tongue

( Myeong Jin Park ),( Gi Hyun Sung ),( Minkee Park ),( Mi Soo Choi ),( Seung Phil Hong ),( Byung Cheol Park ),( Myung Hwa Kim ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Proliferative myositis is characterized by a rare, benign, probably reactive pseudocarcinomatous fibroblastic proliferation that typically presents as a rapidly growing, soft tissue mass. It is frequently misdiagnosed as a malignant lesion because the rapid growth and unusual histologic appearance. There have been numerous previous reports supporting its spontaneous regression and disappearance of the lesion in a couple of weeks. It is, therefore, sufficient to careful follow up to ensure complete resolution of the lesion. A 57-year-old female presented with non-tender well defined indurated solitary hard papule on the median sulcus of the tongue for 2 weeks. There were 2 bleeding events. Histologic examination revealed that ulcer with inflamed granulation tissue was in upper part of the lesion and numerous fibroblastic or myofibroblastic spindle cells and large ganglion-like cells were infiltrating between and around muscle fascicles. Immunohistochemical stains showed positivity in vimentin, smooth muscle actin, CD68 and negativity in S-100. Based on these characteristic clinical findings and histopathologic features, the patient was diagnosed with proliferative myositis. Herein, we report a rare case of proliferative myositis developed on tongue and recommend to consider proliferative myositis in the differential diagnosis when physician meet a rapidly grown soft tissue mass.

심한 근육염이 동반된 Mumps 바이러스 감염증 1예

김석배,허재형,홍석균,신정우,김인호,배현주,조정희,이주연,박종원 대한감염학회 1999 감염 Vol.31 No.3

5-FU, Cisplatin 사용 후 발생한 방사선 회상 근염 1예

유양선 ( Yang Seon Ryu ),전찬홍 ( Chan Hong Jeon ) 대한류마티스학회 2012 대한류마티스학회지 Vol.19 No.1

Radiation recall phenomenon is an inflammatory reaction which occurs at a previously irradiated area after the administration of causative agents, especially anticancer drugs. Radiation recall mostly involves skin and rarely affects internal organs. We, hereby, report a rare case of radiation recall myositis. A 51-years-old man visited the hospital due to pain and weakness of the left thigh. He had been diagnosed with a skin metastasis of pancreatic adenocarcinoma, at the left thigh and treated with radiotherapy and subsequent combination chemotherapy of 5-FU and cisplatin. After the 5th cycle of chemotherapy, the patient developed pain and weakness localized at the previous radiation field. An MRI revealed myositis of left gluteus medius muscle. Muscle biopsy showed no malignant cells or signs of infection. He was diagnosed as having radiation recall myositis and treated with steroid and NSAID. Soon after, pain and weakness gradually improved. Although rare, a possibility of radiation recall myositis should be considered when a patient with history of radiotherapy has a myopathy.

Case Report : Localized Gastrocnemius Myositis in Crohn`s Disease

( Hye Won Kim ),( Han Hee Ryu ),( Sang Jin Lee ),( In Sung Song ),( Yeong Wook Song ),( Eun Young Lee ) 대한류마티스학회 2013 대한류마티스학회지 Vol.20 No.4

We describe a case of localized gastrocnemius myositis which developed with flare-up of Crohn`s disease. A 21-year old male patient with an 8-year history of Crohn`s disease presented with pain and tenderness in both calves without recent abdominal symptoms. Electromyography and gastrocnemius muscle biopsy revealed evidence of inflammatory myositis. Magnetic resonance imaging (MRI) showed bilateral symmetrical diffuse increased signal intensity in T2 weighted images in both gastrocnemius muscles and patchy contrast enhancement. Subsequent gastrointestinal investigation revealed active inflammation of colon with multiple pseudopolyps and enteroenteric fistula on which we commenced oral prednisolone of 30 mg daily. His pain on both calves was improved and muscle enzymes became normal. Following dose reduction of prednisolone, azathioprine 50 mg daily was started considering the patient`s active Crohn`s disease on endoscopic findings prior to the development of overt abdominal symptoms. This is the first case report of localized gastrocnemius myositis associated with Crohn`s disease described in Korea. Calf myositis responded to corticosteroid well and did not recur with maintenance therapy using azathioprine and mesalazine.

Focal Eosinophilic Myositis Associated with Behcet's Disease

( Jung Su Eun ),( Jong Wan Kang ),( Jin Young Kang ),( Na Ri Kim ),( Sang Jin Lee ),( Young Mo Kang ),( Man Hoon Han ),( Eon Jeong Nam ) 대한류마티스학회 2017 대한류마티스학회지 Vol.24 No.5

Behcet’s disease (BD) is a systemic vasculitis commonly accompanied by recurrent mucosal ulceration and other systemic manifestations, but rarely by myositis. Focal eosinophilic myositis is the most limited idiopathic eosinophilic myopathy characterized by peripheral blood eosinophilia and/or eosinophilic muscle infiltration. Clinical manifestations include myalgia, muscle weakness, and cutaneous lesions, such as subcutaneous induration and erythema. Given that BD can mimic deep vein thrombosis or pseudotumor, muscle biopsy should be performed to enhance the accuracy of diagnosis. Microscopic examination reveals extensive infiltration of eosinophils and mononuclear cells into muscle, myofiber necrosis, and regeneration. To the best of our knowledge, there have not been any published reports on MEDLINE regarding focal eosinophilic myositis associated with BD. Here, we presented a case of focal eosinophilic myositis associated with intestinal BD in a 23-year-old man who suffered from a large ulcer in the terminal ileum. (J Rheum Dis 2017;24:303-308)