Analysis of Clinical Manifestations and Laboratory Findings in Children with Influenza B-Associated Myositis: A Single Center Study
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Background: Influenza-associated myositis (IAM) is a rare and poorly recognized complication of influenza infec-tion in children, and is characterized by acute onset of severe pain in the lower extremities and a refusal to ambu-late walk. We sought to understand the association between IAM and influenza B infection and to investigate its clinical and laboratory characteristics in affected children.Methods: Influenza B-associated myositis (IBAM) cases diagnosed in the pediatrics department of Wonkwang University Hospital from January 2010 and March 2016 were analyzed retrospectively.Results: Medical records of affected children were examined, and clinical characteristics and laboratory findings were recorded. Of the 536 children diagnosed with influenza B infection, 47 children complained of bilateral calf pain with or without gait disturbance. All children exhibited elevated serum aspartate aminotransferase (AST) lev-el. The median serum creatine kinase (CK) and lactate dehydrogenase (LDH) levels, reportedly elevated in myosi-tis, were 2,597 IU/L and 678 IU/L, respectively. While the immunofluorescence test results were negative for some patients, the polymerase chain reaction test results indicated influenza B infection in all 47 children. At the time of hospital discharge, the patients’ symptoms had resolved, and their CK levels had improved.Conclusion: IBAM was generally benign and short, and although the blood AST, CK, and LDH levels were marked-ly high, the erythrocyte sedimentation rate and C-reactive protein levels were normal. Further, the duration of IBAM symptoms correlated with the duration of fever. The IBAM-associated clinical and laboratory findings are highly characteristic and may allow its rapid diagnosis during the influenza season.
Abstract
Background: Influenza-associated myositis (IAM) is a rare and poorly recognized complication of influenza infec-tion in children, and is characterized by acute onset of severe pain in the lower extremities and a refusal to ambu-late walk. We sought to understand the association between IAM and influenza B infection and to investigate its clinical and laboratory characteristics in affected children.Methods: Influenza B-associated myositis (IBAM) cases diagnosed in the pediatrics department of Wonkwang University Hospital from January 2010 and March 2016 were analyzed retrospectively.Results: Medical records of affected children were examined, and clinical characteristics and laboratory findings were recorded. Of the 536 children diagnosed with influenza B infection, 47 children complained of bilateral calf pain with or without gait disturbance. All children exhibited elevated serum aspartate aminotransferase (AST) lev-el. The median serum creatine kinase (CK) and lactate dehydrogenase (LDH) levels, reportedly elevated in myosi-tis, were 2,597 IU/L and 678 IU/L, respectively. While the immunofluorescence test results were negative for some patients, the polymerase chain reaction test results indicated influenza B infection in all 47 children. At the time of hospital discharge, the patients’ symptoms had resolved, and their CK levels had improved.Conclusion: IBAM was generally benign and short, and although the blood AST, CK, and LDH levels were marked-ly high, the erythrocyte sedimentation rate and C-reactive protein levels were normal. Further, the duration of IBAM symptoms correlated with the duration of fever. The IBAM-associated clinical and laboratory findings are highly characteristic and may allow its rapid diagnosis during the influenza season.
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