J Rheum Dis.  2013 Aug;20(4):256-260. 10.4078/jrd.2013.20.4.256.

Localized Gastrocnemius Myositis in Crohn's Disease

• Kim HW
• Ryu HH
• Lee SJ
• Song IS
• Song YW
• Lee EY

• KMID: 2297542
• DOI: http://doi.org/10.4078/jrd.2013.20.4.256

Abstract

We describe a case of localized gastrocnemius myositis which developed with flare-up of Crohn's disease. A 21-year old male patient with an 8-year history of Crohn's disease presented with pain and tenderness in both calves without recent abdominal symptoms. Electromyography and gastrocnemius muscle biopsy revealed evidence of inflammatory myositis. Magnetic resonance imaging (MRI) showed bilateral symmetrical diffuse increased signal intensity in T2 weighted images in both gastrocnemius muscles and patchy contrast enhancement. Subsequent gastrointestinal investigation revealed active inflammation of colon with multiple pseudopolyps and enteroenteric fistula on which we commenced oral prednisolone of 30 mg daily. His pain on both calves was improved and muscle enzymes became normal. Following dose reduction of prednisolone, azathioprine 50 mg daily was started considering the patient's active Crohn's disease on endoscopic findings prior to the development of overt abdominal symptoms. This is the first case report of localized gastrocnemius myositis associated with Crohn's disease described in Korea. Calf myositis responded to corticosteroid well and did not recur with maintenance therapy using azathioprine and mesalazine.

Keyword

Localized gastrocnemius myositis; Crohn's disease; Inflammatory bowel disease; Magnetic resonance

MeSH Terms

Azathioprine
Biopsy
Colon
Crohn Disease
Electromyography
Fistula
Humans
Inflammation
Inflammatory Bowel Diseases
Korea
Magnetic Resonance Imaging
Male
Mesalamine
Muscle, Skeletal
Muscles
Myositis
Prednisolone
Azathioprine
Mesalamine
Prednisolone

Figure

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  Figure 1. Both lower leg MRI showed bilateral symmetrical diffuse signal alteration of gastrocnemius muscles and patchy contrast enhancement (arrow) consis-tent with inflammatory myositis.

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  Figure 2. Biopsy of the left lateral gastrocnemius muscle revealed that there is a mild size variation of myofibers and inflammatory cell infiltration in the endomysium and perivsacular area. Some degenerating and regenerating myofibers are shown. Internal nuclei are not prominent. There is mild fibrosis and fat ingrowth in the endomysium but no evidence of vasculitis.

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  Figure 3. (A) Colonoscopy showing cobble stone appearance over cecum, IC valve, terminal ileum and longitudinal ulcer along the mesenteric border of terminal ileum were observed. (B) Small bowel barium enema showing multifocal pseudosacculation in the antime-senteric border with interpositio-ning of the normal ileum was found. Irregular contrast leakage in the right lower quadrant area were visible, apparently suggesting enteroenteric fistula confined to me-sentery (arrow).

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  Figure 4. Serial changes in laboratory data.

Reference

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