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Benign acute childhood myositis: importance of early recognition

09 May 2019
12 min read
Volume 28 · Issue 9

Abstract

Cases of children presenting with limb or joint pain are relatively common and are due mainly to benign conditions. Early diagnosis will help reduce unnecessary invasive investigations so, although a relatively rare condition, benign acute childhood myositis (BACM), which presents with acute lower limb pain and an isolated rise in creatine kinase, should be considered. BACM is characterised by an infiltration of viruses into calf muscle fibres, which may cause a subsequent inflammatory response leading to calf-muscle pain. Symptomatic and supportive management, along with explanation and reassurance, is all that is required in managing this condition. This article discusses the management of a 10-year-old boy with a classical presentation of BACM, alongside differentials and management for clinician consideration.

Children with lower limb pain is a relatively common presentation in clinical practice, and can be one of a range of differential diagnoses. It is important that health professionals are able to recognise the clinical presentation of a septic joint and also develop an approach for the initial assessment and management of a child presenting with limb pain (Tse and Laxer, 2006).

Benign acute childhood myositis (BACM) is a relatively rare and transient condition of acute lower limb pain in children, which is manifested by sudden onset of leg pain and tenderness over the calf muscles. It is an under-recognised condition in clinical practice and an area where little research has been done recently. A search of PubMed using the term ‘benign acute childhood myositis’ returned 48 hits, 44 of which were relevant to the topic and all of these were published in medical journals.

BACM usually starts after a period of rest and is characterised by a refusal or inability to walk. It typically occurs after a viral illness, especially after an influenza infection (Mackay et al, 1999; Paul et al, 2017; Szenborn et al, 2018). Although rare, the condition can cause severe pain in the lower extremities, which can debilitate the child for up to 1 week and may cause significant distress to the child and their family (Koliou et al, 2010). A key biochemical marker in BACM is elevated creatine kinase (CK) due to muscle tissue breakdown; however, the condition is self-limiting, generally requiring conservative management only. This article presents the case of a 10-year-old boy with subacute bilateral leg pain following a viral illness, which limited his mobility.

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