Benign Acute Childhood Myositis (BACM) and Rhabdomyolysis: An Alarming Presentation of Acute Pediatric Pseudoparalysis
AAPA ePoster library. Diemer D. 05/17/17; 180543; 211
Donald Diemer
Donald Diemer
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Abstract
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Benign acute childhood myositis (BACM) has a unique and alarming presentation that is often missed or overlooked. Presented is a case in which careful history, physical examination, and laboratory studies resulted in the diagnosis, while avoiding costly and invasive testing. Once recognized, the case discusses the management of BACM, and its potential complications, namely rhabdomyolysis, as well as the underlying pathophysiology of the disease. 9-year-old male presented to the ED with 'inability to walk' and extreme lower extremity muscle pain. The symptoms began 1 day ago, progressed in severity, and are made worse with any movement. History revealed no trauma or prior occurrence. The patient was recently treated for an upper respiratory infection with Azithromycin, and that has resolved. Further medical, social, and family histories were unremarkable. Vital signs were normal. General inspection revealed a well developed, well nourished, 9-year-old Caucasian male who appeared uncomfortable, but was pleasant and interactive. Musculoskeletal examination revealed tenderness to palpation of all muscle groups of the lower extremities bilaterally. Passive and active range of motion of the lower extremities resulted in marked increase in pain. During attempted standing and walking, the patient fixed his legs in a stiff, straight position, with his feet in external rotation. He was unable stand from sitting, walk, or bear weight without assistance. There was no atrophy, deformity, or evidence of trauma. No neurological deficits were found and all remaining physical exams were unremarkable. Lab work revealed a Creatine Kinase (CK) level of 17,262 U/L. Additional labs showed low platelets, low white blood cell count, elevated AST and ALT, and myoglobinurea. The patient was admitted with the diagnosis of BACM and rhabdomyolysis. Supportive treatment and aggressive hydration were employed and the patient was fully recovered without sequela in 12 days, 4 of which were in the hospital. Clinical pearls of BACM, as discussed in this case include: myalgia in pediatrics, BACM male predominance, viral associations, refusal to bear weight, 'Frankenstein' gait, localization to gastrocnemius soleus muscles, extremely elevated CK levels, no neurological or strength deficits, avoidance of invasive testing, screening for rhabdomyolysis, supportive treatment, and prognosis...
Benign acute childhood myositis (BACM) has a unique and alarming presentation that is often missed or overlooked. Presented is a case in which careful history, physical examination, and laboratory studies resulted in the diagnosis, while avoiding costly and invasive testing. Once recognized, the case discusses the management of BACM, and its potential complications, namely rhabdomyolysis, as well as the underlying pathophysiology of the disease. 9-year-old male presented to the ED with 'inability to walk' and extreme lower extremity muscle pain. The symptoms began 1 day ago, progressed in severity, and are made worse with any movement. History revealed no trauma or prior occurrence. The patient was recently treated for an upper respiratory infection with Azithromycin, and that has resolved. Further medical, social, and family histories were unremarkable. Vital signs were normal. General inspection revealed a well developed, well nourished, 9-year-old Caucasian male who appeared uncomfortable, but was pleasant and interactive. Musculoskeletal examination revealed tenderness to palpation of all muscle groups of the lower extremities bilaterally. Passive and active range of motion of the lower extremities resulted in marked increase in pain. During attempted standing and walking, the patient fixed his legs in a stiff, straight position, with his feet in external rotation. He was unable stand from sitting, walk, or bear weight without assistance. There was no atrophy, deformity, or evidence of trauma. No neurological deficits were found and all remaining physical exams were unremarkable. Lab work revealed a Creatine Kinase (CK) level of 17,262 U/L. Additional labs showed low platelets, low white blood cell count, elevated AST and ALT, and myoglobinurea. The patient was admitted with the diagnosis of BACM and rhabdomyolysis. Supportive treatment and aggressive hydration were employed and the patient was fully recovered without sequela in 12 days, 4 of which were in the hospital. Clinical pearls of BACM, as discussed in this case include: myalgia in pediatrics, BACM male predominance, viral associations, refusal to bear weight, 'Frankenstein' gait, localization to gastrocnemius soleus muscles, extremely elevated CK levels, no neurological or strength deficits, avoidance of invasive testing, screening for rhabdomyolysis, supportive treatment, and prognosis...
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