Three cases of acute myositis in adults following influenza-like illness during the H1N1 pandemic
A 45-year-old male presented with four days of progressive weakness and pain. He first noticed trouble manipulating small objects with his fingers. The weakness in his hand progressed to the point that he was no longer able to perform his job as a cable installer. He reported his forearms were tender to the touch. The patient's wife had confirmed H1N1 influenza four weeks prior, requiring hospitalization. He also had a fever, cough and sore throat shortly after his wife was sick, but did not seek medical attention. He had otherwise been in his usual state of good health with no medication use or recent trauma.\nVital signs and general examination were normal. There was no evidence of skin rash. His muscles were tender to the touch. His neurological examination was notable for decreased strength to grade 4+/5 in bilateral upper extremities, hip flexors and hip extenders. Reflexes and sensory examination were normal.\nLaboratory values were generally unremarkable with the exception of a CK of 600 ng/ml. Pertinent negative virologic tests included CSF bacterial culture, Influenza A by PCR, Influenza B by PCR, and CSF Influenza by PCR.\nThe day following admission his strength had returned to 5/5 and the muscle soreness had resolved. His CK declined to 410 ng/ml and serum creatinine remained stable and within normal limits. He had been given IV fluids and ibuprofen.