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Viral myositis

INTRODUCTION

The clinical spectrum of muscle syndromes associated with viral infections ranges from benign commonly experienced myalgias to rhabdomyolysis with myoglobinuric renal failure.

This topic will review the clinical, pathologic, and diagnostic features of these illnesses. The evaluation of adults and children with muscle weakness, as well as the causes, clinical manifestations, and diagnosis of rhabdomyolysis, is discussed separately. (See "Approach to the patient with muscle weakness" and "Etiology and evaluation of the child with muscle weakness" and "Causes of rhabdomyolysis" and "Clinical manifestations and diagnosis of rhabdomyolysis".)

MYALGIAS

Mild to moderate diffuse myalgias occur frequently during the prodrome or early phase of any acute viral infection. The back and proximal extremities are commonly involved, and mild muscle tenderness may occur without weakness or laboratory abnormalities suggestive of muscle inflammation or necrosis. These self-limited myalgias are probably due to the effect of viral-induced cytokines on muscle tissue, rather than to direct viral invasion of muscle [1].

BENIGN ACUTE CHILDHOOD MYOSITIS

An intermediate muscle syndrome accompanying acute viral infections is primarily seen in children [2]. It consists of marked pain and tenderness, usually localized to the calves. This presentation has been reported most commonly with influenza A or B infections. It is often seen during influenza epidemics and has been described with the 2009 to 2010 pandemic influenza A (H1N1) virus [3]. It occurs as the acute illness is subsiding, usually 24 to 48 hours after the resolution of the presenting symptoms of fever, cough, and coryza.

Patients will often refuse to walk or will have difficulty walking due to pain or to true muscle weakness. The ankles are held in a plantar flexed position, and the patient will resist attempts to dorsiflex the ankle because of pain [4,5]. Benign acute childhood myositis should be included in the differential diagnosis of children with sudden difficulty walking [6].

          

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Literature review current through: Apr 2013. | This topic last updated: Dec 18, 2012.
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References
Top
  1. Stang H. Acute transient myositis associated with influenza virus infection. Pediatr Infect Dis J 1989; 8:257.
  2. Mackay MT, Kornberg AJ, Shield LK, Dennett X. Benign acute childhood myositis: laboratory and clinical features. Neurology 1999; 53:2127.
  3. Koliou M, Hadjiloizou S, Ourani S, et al. A case of benign acute childhood myositis associated with influenza A (H1N1) virus infection. Clin Microbiol Infect 2010; 16:193.
  4. Middleton PJ, Alexander RM, Szymanski MT. Severe myositis during recovery from influenza. Lancet 1970; 2:533.
  5. Farrell MK, Partin JC, Bove KE. Epidemic influenza myopathy in Cincinnati in 1977. J Pediatr 1980; 96:545.
  6. Zafeiriou DI, Katzos G, Gombakis N, et al. Clinical features, laboratory findings and differential diagnosis of benign acute childhood myositis. Acta Paediatr 2000; 89:1493.
  7. Dietzman DE, Schaller JG, Ray CG, Reed ME. Acute myositis associated with influenza B infection. Pediatrics 1976; 57:255.
  8. Ruff RL, Secrist D. Viral studies in benign acute childhood myositis. Arch Neurol 1982; 39:261.
  9. Mannix R, Tan ML, Wright R, Baskin M. Acute pediatric rhabdomyolysis: causes and rates of renal failure. Pediatrics 2006; 118:2119.
  10. Shenouda A, Hatch FE. Influenza A viral infection associated with acute renal failure. Am J Med 1976; 61:697.
  11. Cunningham E, Kohli R, Venuto RC. Influenza-associated myoglobinuric renal failure. JAMA 1979; 242:2428.
  12. Gamboa ET, Eastwood AB, Hays AP, et al. Isolation of influenza virus from muscle in myoglobinuric polymyositis. Neurology 1979; 29:1323.
  13. Abe M, Higuchi T, Okada K, et al. Clinical study of influenza-associated rhabdomyolysis with acute renal failure. Clin Nephrol 2006; 66:166.
  14. D'Silva D, Hewagama S, Doherty R, et al. Melting muscles: novel H1N1 influenza A associated rhabdomyolysis. Pediatr Infect Dis J 2009; 28:1138.
  15. Fodili F, van Bommel EF. Severe rhabdomyolysis and acute renal failure following recent Coxsackie B virus infection. Neth J Med 2003; 61:177.
  16. Friedman BI, Libby R. Epstein-Barr virus infection associated with rhabdomyolysis and acute renal failure. Clin Pediatr (Phila) 1986; 25:228.
  17. McCabe JL, Duckett S, Kaplan P. Epstein-Barr virus infection complicated by acute rhabdomyolysis. Am J Emerg Med 1988; 6:453.
  18. Schlesinger JJ, Gandara D, Bensch KG. Myoglobinuria associated with herpes-group viral infections. Arch Intern Med 1978; 138:422.
  19. O'Connor JV, Iyer SK. Myoglobinuria associated with parainfluenza type 2 infection. N Y State J Med 1982; 82:1469.
  20. Wright J, Couchonnal G, Hodges GR. Adenovirus type 21 infection. Occurrence with pneumonia, rhabdomyolysis, and myoglobinuria in an adult. JAMA 1979; 241:2420.
  21. Meshkinpour H, Vaziri ND. Association of myoglobinuria with adenovirus infection. West J Med 1982; 137:130.
  22. Josselson J, Pula T, Sadler JH. Acute rhabdomyolysis associated with an echovirus 9 infection. Arch Intern Med 1980; 140:1671.
  23. Hughes GS Jr, Hunt R. Cytomegalovirus infection with rhabdomyolysis and myoglobinuria. Ann Intern Med 1984; 101:276.
  24. Seibold S, Merkel F, Weber M, Marx M. Rhabdomyolysis and acute renal failure in an adult with measles virus infection. Nephrol Dial Transplant 1998; 13:1829.
  25. Hollenstein U, Thalhammer F, Burgmann H. Disseminated intravascular coagulation (DIC) and rhabdomyolysis in fulminant varicella infection--case report and review of the literature. Infection 1998; 26:306.
  26. Mahé A, Bruet A, Chabin E, Fendler JP. Acute rhabdomyolysis coincident with primary HIV-1 infection. Lancet 1989; 2:1454.
  27. Guillaume MP, Van Beers D, Delforge ML, et al. Primary human immunodeficiency virus infection presenting as myopericarditis and rhabdomyolysis. Clin Infect Dis 1995; 21:451.
  28. Acharya S, Shukla S, Mahajan SN, Diwan SK. Acute dengue myositis with rhabdomyolysis and acute renal failure. Ann Indian Acad Neurol 2010; 13:221.
  29. Craighead JE, Huber SA, Sriram S. Animal models of picornavirus-induced autoimmune disease: their possible relevance to human disease. Lab Invest 1990; 63:432.
  30. Hocking WG, Reza MJ. Letter: Nontraumatic rhabdomyolysis and renal failure. N Engl J Med 1975; 292:979.
  31. Paletta CE, Lynch R, Knutsen AP. Rhabdomyolysis and lower extremity compartment syndrome due to influenza B virus. Ann Plast Surg 1993; 30:272.
  32. Dunnet J, Paton JY, Robertson CE. Acute renal failure and Coxsackie viral infection. Clin Nephrol 1981; 16:262.
  33. Tanaka T, Takada T, Takagi D, et al. Acute renal failure due to rhabdomyolysis associated with echovirus 9 infection: a case report and review of literature. Jpn J Med 1989; 28:237.
  34. Christenson JC, San Joaquin VH. Influenza-associated rhabdomyolysis in a child. Pediatr Infect Dis J 1990; 9:60.
  35. Kessler HA, Trenholme GM, Harris AA, Levin S. Acute myopathy associated with influenza A/Texas/1/77 infection. Isolation of virus from a muscle biopsy specimen. JAMA 1980; 243:461.
  36. Greco TP, Askenase PW, Kashgarian M. Postviral myositis: myxovirus-like structures in affected muscle. Ann Intern Med 1977; 86:193.
  37. Fukuyama Y, Ando T, Yokota J. Acute fulminant myoglobinuric polymyositis with picornavirus-like crystals. J Neurol Neurosurg Psychiatry 1977; 40:775.
  38. Knochel JP. Environmental heat illness. An eclectic review. Arch Intern Med 1974; 133:841.
  39. Schwaber MJ, Liss HP, Steiner I, Brezis M. Hazard of sauna use after strenuous exercise. Ann Intern Med 1994; 120:441.
  40. Singhal PC, Abramovici M, Venkatesan J. Rhabdomyolysis in the hyperosmolal state. Am J Med 1990; 88:9.
  41. Tonin P, Lewis P, Servidei S, DiMauro S. Metabolic causes of myoglobinuria. Ann Neurol 1990; 27:181.
  42. Armstrong JH. Tropical pyomyositis and myoglobinuria. Arch Intern Med 1978; 138:1145.
  43. Naschitz JE, Yeshurun D, Shagrawi I. Rhabdomyolysis in pneumococcal sepsis. Am J Med 1989; 87:479.
  44. Tein I, DiMauro S, DeVivo DC. Recurrent childhood myoglobinuria. Adv Pediatr 1990; 37:77.
  45. Kelly KJ, Garland JS, Tang TT, et al. Fatal rhabdomyolysis following influenza infection in a girl with familial carnitine palmityl transferase deficiency. Pediatrics 1989; 84:312.
  46. Caccamo DV, Keene CY, Durham J, Peven D. Fulminant rhabdomyolysis in a patient with dermatomyositis. Neurology 1993; 43:844.
  47. Bennett WR, Huston DP. Rhabdomyolysis in thyroid storm. Am J Med 1984; 77:733.
  48. Riggs JE. Acute exertional rhabdomyolysis in hypothyroidism: the result of a reversible defect in glycogenolysis? Mil Med 1990; 155:171.
  49. Crennan JM, Van Scoy RE, McKenna CH, Smith TF. Echovirus polymyositis in patients with hypogammaglobulinemia. Failure of high-dose intravenous gammaglobulin therapy and review of the literature. Am J Med 1986; 81:35.