Three cases of acute myositis in adults following influenza‑like illness during the H1N1 pandemic

Address for correspondence: Dr. Summer Gibson Department of Neurology, Clinical Neurosciences Center 175 N Medical Drive East, Salt Lake City, Utah 84132 USA summer.gibson@hsc.utah.edu

Journal of Neurosciences in Rural Practice

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Abstract

ABSTRACT

Acute viral myositis is a rare condition that occurs during the recovery phase of an illness, most commonly influenza. It is characterized by muscle pain and weakness with an isolated laboratory finding of elevated serum creatine kinase (CK). We describe three previously healthy patients who were hospitalized after developing myositis following influenza‑like illness during the 2009 influenza A (H1N1) virus pandemic. All experienced myalgias and weakness in all four extremities, including distal upper extremities, associated with an elevated CK level that resolved along with their myalgias and weakness within one week with supportive care. These cases serve as a reminder that influenza‑related myositis may have atypical characteristics depending on the strain of influenza, and clinicians should be open to this possibility when new outbreaks occur.

Keywords

H1N1

influenza

muscle weakness

myositis

viral myositis

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Conflicts of interest

None declared

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[1] Crum-Cianflone N. F., . Bacterial, Fungal, Parasitic, and Viral Myositis. Clin Microbiol Rev. 2008;21:473-94.
[Google Scholar]

[2] Servidei S, Miranda A. F., Gamboa E. T., . Infectivity of influenza B virus in cultured human muscle. Acta Neuropathol. 1987;73:67-76.
[Google Scholar]

[3] Hu J. J., Kao C. L., Lee P. I., Chen C. M., Lee C. Y., Lu C. Y., et al. . Clinical features of influenza A and B in children and association with myositis. J Microbiol Immunol Infect. 2004;37:95-8.
[Google Scholar]

[4] Betakova T, Nermut M. V., Hay A. J., . The NB protein is an integral component of the membrane of influenza B virus. J Gen Virol. 1996;77:2689-94.
[Google Scholar]

[5] Middleton P. J., Alexander R. M., Szymanski M. T., . Severe myositis during recovery from Influenza. Lancet. 1970;2:533-5.
[Google Scholar]

[6] D’-Silva D, Hewagama S, Hoherty R, Korman T, Buttery J, . Melting Muscles: Novel H1N1 Influenza A Associated Rhabdomyolysis. Pediatr Infect Dis J. 2009;28:1138-9.
[Google Scholar]

[7] Carrillo-Esper R, Ornelas-Arroyo S, Pérez-Bustos E, Sanchez-Zuniga J, Uribe-Esquivel M, . Rhabdomyolysis and acute renal failure in human influenza A H1N1 mediated infection. Gac Med Mex. 2009;145:519-21.
[Google Scholar]

[8] Agyeman P, Duppenthaler A, Heininger U, Aebi C, . Influenza-associated myositis in children. Infection. 2004;32:199-203.
[Google Scholar]

[9] Davis L. E., Kornfeld M, . Experimental influenza B viral myositis. J Neurol Sci. 2001;187:61-7.
[Google Scholar]

[10] Oba K, Nishihara A, Okamura K, Ajiro Y, Yamaguchi Y, Okazaki K, et al. . Two Cases of Acute Myositis Associate with Influenza A Virus Infection in the Elderly. J Nippon Med Sch. 2000;67:126-9.
[Google Scholar]

[11] Yoshino M, Suzuki S, Adachi K, Fukayama M, Inamatsu T, . High incidence of acute myositis with type A influenza virus infection in the elderly. Intern Med. 2000;39:431-2.
[Google Scholar]

[12] Centers for Disease Control and Prevention , . Outbreak of swine-origin influenza A (H1N1) virus infection-Mexico, March-April 2009. Morb Mortal Wkly Rep. 2009;58:467-70.
[Google Scholar]

[13] Patel M, Dennis A, Flutter C, Khan Z, . Pandemic (H1N1) 2009 influenza. Br J Anaesth. 2010;104:128-42.
[Google Scholar]

[14] Chan M, . World now at the start of 2009 influenza pandemic 2009. June 11 [World Health Organization web site]. Available from [Last accessed on 2010 Feb 18]
[Publisher] [Google Scholar]

[15] UTAH-2009-2010 , . Influenza Season Weekly Update May 26 [Utah Department of Health- H1N1 web site] Available from [Last accessed on 2010 July 7]
[Publisher]

[16] Swine Flu (H1N1) in Utah. April 7 [2010 H1N1 Flu-Virus web site]. Available from: [Last accessed on 2010 April 7]
[Publisher]

[17] Koliou M, Hadjiloizou S, Ourani S, Demosthenous A, Hadjidemetriou A, . A case of benign acute childhood myositis associated with influenza A (H1N1) virus infection. Clin Microbiol Infect. 2010;16:193-5.
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[18] Rubín E, De la Rubia L, Pascual A, Domínguez J, Flores C, . Benign acute myositis associated with H1N1 influenza A virus infection. Eur J Pediatr. 2010;169:1159-61.
[Google Scholar]

[19] Interim WHO guidance for the surveillance of human infection with swine influenza A (H1N1) virus. July 10 [World Health Organization web site]. Available from [Last accessed on 2010 Feb 20]
[Publisher] [Google Scholar]

[20] Interim Guidance for the Detection of Novel Influenza A Virus Using Rapid Influenza Diagnostic Test [CDC, H1N1 flu web site] Aug 10 Available from [Last accessed on 2010 Feb 20]
[Publisher] [Google Scholar]

[21] Na S, Chong Y. P., Kim M. N., Kim W. Y., Kim W, Hong S. B., et al. . Duration of viral shedding in patients admitted to hospital with pandemic influenza A/H1N1 2009 infection. J Med Virol. 2011;83:5-9.
[Google Scholar]

[22] Ling L. M., Chow A. L., Lye D. C., Tan A. S., Krishnan P, Cui L, et al. . Effects of early oseltamivir therapy on viral shedding in 2009 pandemic influenza A (H1N1) virus infection. Clin Infect Dis. 2010;50:963-9.
[Google Scholar]

[23] Hien T. T., Boni M. F., Bryant J. E., Ngan T. T., Wolbers M, Nguyen T. D., et al. . Early pandemic influenza (2009 H1N1) in Ho Chi Minh City, Vietnam: A clinical virological and epidemiological analysis. PLoS Med. 2010;7:e1000277.
[Google Scholar]

[24] Ito Y, Ichiyama T, Kimura H, Shibata M, Ishiwada N, Kuroki H, et al. . Detection of influenza virus RNA by reverse transcription-PCR and proinflammatory cytokines in influenza-virus-associated encephalopathy. J Medical Virology. 1999;58:420-5.
[Google Scholar]

[25] Steininger C, Popow-Kraupp T, Laferl H, Seiser A, Gödl I, Djamshidian S, et al. . Actue encephalopathy associated with influenza A virus infection. Clin Infect Dis. 2003;36:567-74.
[Google Scholar]

[26] Sjvar J. J., Uyeki T. M., . Neurologic complications of 2009 influenza A (H1N1) Neurology. 2010;74:1020-1.
[Google Scholar]

[27] Monto A. S., Gravenstein S, Elliott M, Colopy M, Schweinle J, et al. . Clinical signs and symptoms predicting influenza infection. Arch Intern Med. 2000;160:3243-7.
[Google Scholar]