A case of eosinophilic myositis in continuum from localized nodular myositis

Dai Matsuse, Koji Ikezoe, Hiroshi Shigeto, Hiroyuki Murai, Yasumasa Ohyagi, Jun-Ichi Kira

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Abstract

We report a 72-year-old man with eosinophilic myositis (EM). At age 71 he noticed a painful nodule in his left calf. A biopsy (first biopsy) showed marked infiltration of mononucleated cells and necrotic muscle fibers. Several phagocytosed fibers were also seen. He was diagnosed as having myositis. The painful nodule disappeared spontaneously. At age 72, he again had a painful nodule, but this time in his right calf; again, this disappeared spontaneously on the first admission. Just after discharge, he noted painful nodules in the left thigh and right anterior tibial muscles and was again admitted (second admission). Neurological examination revealed mild proximal-dominant weakness in all four extremities but no other abnormalities. Laboratory studies showed elevated creatine kinase (CK) level (38,803 U/l; normal 62-287) and positive Jo-1 antibody, but no eosinophilia. Needle electromyography of the limb muscles showed myogenic patterns. Magnetic resonance imaging of the lower limbs demonstrated several T2-high and gadolinium (Gd)-enhanced lesions. Muscle biopsy (second biopsy) from the left quadriceps femoris showed marked infiltration of eosinophils; he was diagnosed as having EM. Administration of prednisolone was initiated at 60 mg/day and then gradually tapered. After starting treatment with steroids, his muscle weakness gradually ameliorated, CK level dramatically decreased, and the nodules disappeared. Clinically, the patient had developed localized nodular myositis (LNM), but pathologically it was EM without peripheral blood eosinophilia and positive Jo-1 antibody that is occasionally found in polymyositis (PM). Thus, this patient demonstrated overlapping characteristics of EM, LNM, and possibly PM, suggesting that a common mechanism underlay these conditions. As discussed, the involvement of eosinophils in three inflammatory myopathies was indicated.

Original languageEnglish
Pages (from-to)36-42
Number of pages7
JournalClinical Neurology
Volume48
Issue number1
DOIs
Publication statusPublished - Jan 1 2008

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Myositis
Biopsy
Polymyositis
Eosinophilia
Creatine Kinase
Eosinophils
Extremities
Muscles
Muscle Weakness
Quadriceps Muscle
Neurologic Examination
Gadolinium
Electromyography
Prednisolone
Thigh
Phagocytosis
Muscle Cells
Needles
Lower Extremity
Skeletal Muscle

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

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A case of eosinophilic myositis in continuum from localized nodular myositis. / Matsuse, Dai; Ikezoe, Koji; Shigeto, Hiroshi; Murai, Hiroyuki; Ohyagi, Yasumasa; Kira, Jun-Ichi.

In: Clinical Neurology, Vol. 48, No. 1, 01.01.2008, p. 36-42.

Research output: Contribution to journalArticle

Matsuse, Dai ; Ikezoe, Koji ; Shigeto, Hiroshi ; Murai, Hiroyuki ; Ohyagi, Yasumasa ; Kira, Jun-Ichi. / A case of eosinophilic myositis in continuum from localized nodular myositis. In: Clinical Neurology. 2008 ; Vol. 48, No. 1. pp. 36-42.
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