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Severe Rhabdomyolysis without Systemic Involvement: A Rare Case of Idiopathic Eosinophilic Polymyositis.

Farooq A, Choksi V, Chu A, Mankodi D, Shaharyar S, O'Brien K, Shankar U - Case Rep Rheumatol (2015)

Bottom Line: She was started on high dose systemic corticosteroids with improvement of her symptoms, eosinophilia, and CPK level.Discussion.Clinicians should maintain a high index of suspicion for this physically debilitating disease to aid in prompt diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Aventura Hospital and Medical Center Internal Medicine Department, Aventura, FL 33180, USA.

ABSTRACT
Introduction. Eosinophilic polymyositis (EPM) is a rare cause of rhabdomyolysis characterized by eosinophilic infiltrates in the muscle. We describe the case of a young patient with eosinophilic polymyositis causing isolated severe rhabdomyolysis without systemic involvement. Case Presentation. A 22-year-old Haitian female with no past medical history presented with progressive generalized muscle aches without precipitating factors. Examination of the extremities revealed diffuse muscle tenderness. Laboratory findings demonstrated peripheral eosinophilia and high creatinine phosphokinase (CPK) and transaminase levels. Workup for the common causes of rhabdomyolysis were negative. Her CPK continued to rise to greater than 100,000 units/L so a muscle biopsy was performed which showed widespread eosinophilic infiltrate consistent with eosinophilic polymyositis. She was started on high dose systemic corticosteroids with improvement of her symptoms, eosinophilia, and CPK level. Discussion. This case illustrates a systematic workup of rhabdomyolysis in the presence of peripheral eosinophilia. Many differential diagnoses must be considered before establishing a diagnosis of idiopathic eosinophilic polymyositis. To our knowledge, our case of eosinophilic polymyositis is unique as it presented with severe rhabdomyolysis without another organ involvement. Clinicians should maintain a high index of suspicion for this physically debilitating disease to aid in prompt diagnosis.

No MeSH data available.


Related in: MedlinePlus

Cross section of skeletal muscle biopsy using H&E stain showing generalized myofiber atrophy with eosinophilic infiltrates (arrow) in the endomysium.
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fig1: Cross section of skeletal muscle biopsy using H&E stain showing generalized myofiber atrophy with eosinophilic infiltrates (arrow) in the endomysium.

Mentions: Her muscle biopsy demonstrated widespread eosinophilic infiltrate consistent with eosinophilic polymyositis as well as numerous plasma cells (Figure 1). There were no parasites like Toxoplasma or Trichinella seen on H&E stain. There were no hydatid cysts seen on biopsy making Echinococcus unlikely. While Toxoplasma and Taenia solium were not specifically tested for by serology, our patient did not display gastrointestinal or neurological symptoms to support these pathologies. SPEP and UPEP were normal making multiple myeloma unlikely. We did not suspect a hematological malignancy warranting a bone marrow biopsy. This biopsy result was not consistent with rhabdomyolysis caused by influenza based on review of the literature. Given significant improvement with steroids, this treatment was continued and the patient was advised to follow up with a neuromuscular disease specialist. She was seen in our internal medicine clinic after discharge and a slow steroid taper was continued for 6 months with successful remission of symptoms and normalization of CPK and liver enzyme levels, which would not be expected if an infectious entity were the cause.


Severe Rhabdomyolysis without Systemic Involvement: A Rare Case of Idiopathic Eosinophilic Polymyositis.

Farooq A, Choksi V, Chu A, Mankodi D, Shaharyar S, O'Brien K, Shankar U - Case Rep Rheumatol (2015)

Cross section of skeletal muscle biopsy using H&E stain showing generalized myofiber atrophy with eosinophilic infiltrates (arrow) in the endomysium.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4502331&req=5

fig1: Cross section of skeletal muscle biopsy using H&E stain showing generalized myofiber atrophy with eosinophilic infiltrates (arrow) in the endomysium.
Mentions: Her muscle biopsy demonstrated widespread eosinophilic infiltrate consistent with eosinophilic polymyositis as well as numerous plasma cells (Figure 1). There were no parasites like Toxoplasma or Trichinella seen on H&E stain. There were no hydatid cysts seen on biopsy making Echinococcus unlikely. While Toxoplasma and Taenia solium were not specifically tested for by serology, our patient did not display gastrointestinal or neurological symptoms to support these pathologies. SPEP and UPEP were normal making multiple myeloma unlikely. We did not suspect a hematological malignancy warranting a bone marrow biopsy. This biopsy result was not consistent with rhabdomyolysis caused by influenza based on review of the literature. Given significant improvement with steroids, this treatment was continued and the patient was advised to follow up with a neuromuscular disease specialist. She was seen in our internal medicine clinic after discharge and a slow steroid taper was continued for 6 months with successful remission of symptoms and normalization of CPK and liver enzyme levels, which would not be expected if an infectious entity were the cause.

Bottom Line: She was started on high dose systemic corticosteroids with improvement of her symptoms, eosinophilia, and CPK level.Discussion.Clinicians should maintain a high index of suspicion for this physically debilitating disease to aid in prompt diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Aventura Hospital and Medical Center Internal Medicine Department, Aventura, FL 33180, USA.

ABSTRACT
Introduction. Eosinophilic polymyositis (EPM) is a rare cause of rhabdomyolysis characterized by eosinophilic infiltrates in the muscle. We describe the case of a young patient with eosinophilic polymyositis causing isolated severe rhabdomyolysis without systemic involvement. Case Presentation. A 22-year-old Haitian female with no past medical history presented with progressive generalized muscle aches without precipitating factors. Examination of the extremities revealed diffuse muscle tenderness. Laboratory findings demonstrated peripheral eosinophilia and high creatinine phosphokinase (CPK) and transaminase levels. Workup for the common causes of rhabdomyolysis were negative. Her CPK continued to rise to greater than 100,000 units/L so a muscle biopsy was performed which showed widespread eosinophilic infiltrate consistent with eosinophilic polymyositis. She was started on high dose systemic corticosteroids with improvement of her symptoms, eosinophilia, and CPK level. Discussion. This case illustrates a systematic workup of rhabdomyolysis in the presence of peripheral eosinophilia. Many differential diagnoses must be considered before establishing a diagnosis of idiopathic eosinophilic polymyositis. To our knowledge, our case of eosinophilic polymyositis is unique as it presented with severe rhabdomyolysis without another organ involvement. Clinicians should maintain a high index of suspicion for this physically debilitating disease to aid in prompt diagnosis.

No MeSH data available.


Related in: MedlinePlus