Three cases of acute myositis in adults following influenza-like illness during the H1N1 pandemic
A 37-year old male surgeon presented with three days of progressive muscle pain and weakness. Five days prior he had fever, myalgias and sore throat. His fever and sore throat resolved after two days, but he continued to have muscle pain that evolved into diffuse muscle weakness, greatest in his distal upper extremities. This disabled him from performing surgery. He denied any recent trauma or strenuous exercise. He also denied any medical history or medication use prior to his illness, except for ibuprofen three days prior to his presentation. He reported multiple sick contacts, including sick patients and his four-month old son.\nHis vital signs and general examination were normal. He had no rashes or joint pain. His forearm muscles and intrinsic muscles of the hand were tight and tender to touch. His neurological examination was notable for 5/5 strength throughout except bilateral wrist flexion and extension (4/5), finger flexion (3/5), finger extension (2/5) and thumb adduction (3/5). His reflexes and sensation were normal.\nLaboratory values were generally unremarkable with the exception of CK (1,504 ng/ml). Pertinent negative virologic tests included RSV by PCR, parvovirus B19, EBV, CSF bacterial culture, HIV, Influenza A by PCR, Influenza B by PCR, and CSF Influenza by PCR.\nHe was given IV fluids and ibuprofen. One day after presentation, the swelling and tenderness improved. Two days later his symptoms had nearly resolved. Examination revealed only subtle 5-/5 weakness in bilateral forearms and hands. CK decreased to 752 ng/ml and serum creatinine remained stable and within normal limits. Nerve conduction and needle EMG (proximal, distal and paraspinal muscles) studies were normal. A few days later he was able to return to work, including performing surgeries.