Gastrocnemius Myalgia as a Rare Initial Manifestation of Crohn's Disease

Abstract

The initial symptoms of Crohn's disease (CD) sometimes present as extraintestinal lesions, which can be a diagnostic challenge for physicians. Painful legs, known as “gastrocnemius myalgia syndrome”, are rare complications that often precede abdominal manifestations. We herein report the case of a 38-year-old man who presented with bilateral leg myalgia lasting for 4 months. Magnetic resonance imaging showed abnormal intensity, and a muscle biopsy revealed inflammatory cell infiltration. Abdominal symptoms appeared three months after the myalgia onset, and the diagnosis of CD was confirmed later by endoscopic and radiological findings. To our knowledge, this is the first description of gastrocnemius myalgia syndrome in Japan.

Focal Myositis Localised in Gastrocnemius Muscle: is it Different from Isolated Gastrocnemius Myositis? A Case Report

“…Among many autoimmune causes in FM such as Behcet disease, SLE, and systemic sclerosis, there have been no reports associated with CD 2 , 3 . IGM, previously reported only in six case reports, is an extremely rare extra-intestinal manifestation in CD; however, its clinical manifestation shows nonspecific findings in laboratory, hematological, radiological, histological, and EMG assessment, as in FM 4 , 5 . In addition, IHS revealed findings associated with CD68-, CD4-, and CD8-positive infiltrates, in necrotic and regenerating muscle fibres 2 .…”

“…Single or combined glucocorticoids with immunosuppressants was also evident in the current study 2 , 5 . In myositis solitarily occurring in gastrocnemius, endoscopy and biopsy are helpful to rule out rheumatic diseases and inflammatory bowel diseases due to the possibility of temporal discrepancy in manifestation of extra-intestinal and intestinal symptoms in CD 4 .…”

“…Previous literature on FM indicated its possible causes associated with radiculopathy, neoplasm, trauma, infection, and autoimmune diseases, most commonly involving skeletal muscles of lower extremity in adductor muscle, vastus lateralis, and gastrocnemius 3 . Another disease entity associated with focally occurring myositis in a single muscle compartment is the isolated gastrocnemius myositis (IGM), an extremely rare form of extra-intestinal manifestation associated with Crohn’s disease (CD) 4 , 5 . FM and IGM share similar clinical, radiological, and histological features and a benign self-limited course of disease.…”

New perspectives on dry needling following a medical model: are we screening our patients sufficiently?

“…Collectively inflammatory bowel disease, one hallmark of both conditions, is migratory arthralgias that can often precede the emergence of GI symptoms such as nausea, diarrhea, constipation, or other constitutional signs and symptoms [31]. Although arthralgia is commonly present, myalgia [34,35] may also be one of the first manifesting symptoms. This underscores the importance of screening for prior history of ulcerative colitis or Crohn's disease.…”

Aphthous stomatitis as the debut of Crohn’s disease

“…Также имеются описания системных атипичных проявлений дебюта болезни Крона с остеопороза [6], аутоиммунного панкреатита, тип 2 [7], миалгии икроножных мышц [8], а также оральных лимфангиэктазий [9]. Атипичная манифестация приводит к значительному удлинению сроков окончательного установления диагноза болезни Крона, и как следствие затягиванию назначения лечения.…”