Acute myositis with transient decrease of albumin, immunoglobulin, and complement following rotavirus gastroenteritis

Abstract

Acute myositis with transient decrease of albumin, immunoglobulin, and complement following rotavirus gastroenteritis MOTOKI BONNO.' MASAMUNE HIGASHIGAWA.' TAKASHI NAKANO,' MASAZUMI MIYAHARA.' EIICHI AZUMA,'.' YOSHIHIRO KOMADA.' MASAHIRO ITO' AND MINORU SAKURAI' iDqxirtiiieiit of' Prclirrtr?cs. 'Depnrti?ierrt cf Cliriicnl iiwrnunology, Mie University Sclzool of Medicine, a r i d .'Abstract A 2-year-old boy developed acute myositis associated with rotavirus gastroenteritis. He had remarkableshelling and subcutaneous edema. mostly i n the legs, 4 days after the onset of gastroenteritis. Marked ele\ ation of creatine kinase was observed while serum albumin, immunoglobulin, and complement were decreaaed.

Acute Myositis Associated with Concurrent Infection of Rotavirus and Norovirus in a 2-Year-Old Girl

“…Moreover, rapid resolution of the clinical symptom associated with concomitant decline in CK level indicates that the damaged tissue was muscle, making it highly unlikely that the girl was affected with Guillain-Barré syndrome. These clinical and laboratory findings were entirely consistent with benign acute myositis as reported in the previous literature, 2 , 3-7 which led to the diagnosis of our patient as acute myositis.…”

“… 5 , 8 A particular subtype of rotavirus may be associated with muscle tropism, although virus subtypes were not determined in our case or in other reports. Our patient developed myositis following cessation of gastroenteritis symptoms, which is similar to other reported cases ( Table 1 ), 2-4 , 9-12 suggesting that an indirect mechanism is likely responsible, rather than direct invasion of the virus into skeletal muscle. The pathogenesis of acute myositis remains unknown, although the immune mediated mechanisms initiated by the hosts are suspected.…”

“…The diagnosis of benign acute myositis in children is usually made based on the typical clinical symptoms, such as symmetrical calf muscle pain, tenderness, inability or refusal to walk a few days after infectious illness, CK elevation that normalizes within 1 week. 7 Although most reported cases with virus associated benign myositis were diagnosed without electrophysiological or cerebrospinal fluid examination, 2 , 3 , 7 these studies would help to exclude other diseases such as Guillain-Barré syndrome. However, our patient demonstrated elevation of CK up to 5547 U/L, which is not usually observed in Guillain-Barré syndrome.…”

“…Previous reports demonstrating an association between rotavirus infection and myositis on rare occasions suggest that myositis was more likely attributed to rotavirus rather than norovirus in our case. 2-4 However, the involvement of norovirus could not be excluded (see below). The mechanism responsible for rotavirus associated myositis is yet to be determined, but it is considered a consequence of direct virus invasion into muscle or an immunological reaction.…”

“… 1 Although they could induce central nervous system disease, only 3 cases with rotavirus-induced acute myositis have been reported in the English literature. 2-4 Acute myositis is often caused by various infectious pathogens, such as mycoplasma pneumonia, influenza virus and adenovirus. 5 In contrast, acute myositis associated with rotavirus or norovirus is seldom reported.…”