Disclosures: Amanda M. Olney, MD: No financial relationships or conflicts of interest

Case Diagnosis: Two previously healthy young men were diagnosed with viral myositis after presenting to the emergency department in the same week with bilateral hand weakness, diffuse myalgias, and oral ulcers.

Case Description: Patient 1 (37-year-old male) presented with bilateral hand and arm weakness, neck flexion weakness, diffuse myalgias, absent arm reflexes, and oral ulcers after brief diarrheal illness. Workup which included MRI, lumbar puncture, and lab work. Results notable for elevated CPK of 641 (normal 60-225 U/L) and CRP of 24.8 (normal less than 10 mg/L). Given patient’s weakness and absent upper limb reflexes, there was concern for acute demyelinating process and patient was given 3 day course of IVIG. Electromyography and nerve conduction studies were performed and were largely normal with exception of mild myopathic recruitment of left finger flexors. CPK downtrended and symptoms began to improve during hospitalization.

Patient 2 (38-year-old male) presented to the same emergency department 3 days after Patient 1 with nearly identical symptoms after brief diarrheal illness. Reflexes were present. Lab work revealed mildly elevated CPK of 420 and CRP of 11.3. Electromyography and nerve conduction studies were largely normal with exception of mild myopathic recruitment of right finger flexors. He was given supportive treatment and discharged from emergency department.

Setting: Acute care

Assessment/Results: Myalgias, weakness, EMG findings, and elevation of CPK were suggestive of viral myositis.

Discussion: Patient 2 presented to the same emergency department three days after Patient 1. Patient 2’s workup was abbreviated as he likely had the same viral illness as Patient 1 given similar geography, symptom characteristics, and EMG findings.

Conclusion: Myositis is associated with many common viruses, and the majority of cases are self-limited. The viral syndrome described may be unique in that the symptoms were nearly identical in two men approximately the same age.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/myalgias-hand-weakness-and-oral-ulcers-two-nearly-identical-cases-of-viral-myositis/