今日の臨床サポート

筋肉痛(全身)

著者: 原田芳巳 東京医科大学病院 総合診療科

監修: 大滝純司 東京医科大学 医学教育学 総合診療科

著者校正/監修レビュー済:2020/05/01
患者向け説明資料

概要・推奨   

  1. 横紋筋融解の患者には詳細な薬剤(漢方、サプリメント、危険ドラッグを含む)使用歴を聴取する必要がある(推奨度1)。
  1. 多発性筋炎では筋力低下なくして筋肉痛や血清CK高値だけで発症することはまずない(推奨度1)。
  1. 血清CK15,000 IU/L以上では急性腎不全(ARF)の発症率が高くなる(推奨度1)。
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  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となりま
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となりま
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薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
原田芳巳 : 特に申告事項無し[2021年]
監修:大滝純司 : 特に申告事項無し[2021年]

改訂のポイント:
  1. 定期レビューを行い、以下について加筆修正を行った。
  1. 線維筋痛症のガイドラインが新しくなった。
  1. 身体表現性障害と言われていたが、DSM-5では身体症状症と病名が変わった。
  1. パルボウイルスB19 IgM抗体の保険適用が変わった。
  1. 流行性筋痛症について記載を追加した。

病態・疫学・診察

疫学情報・病態・注意事項  
  1. 筋肉痛はほとんどの成人が日常生活のなかで経験する。
  1. 原因は多岐にわたるが、過度の運動、外傷、ウイルス感染症が最も一般的な原因である。多くは良性で自然軽快するが、時に重大な疾患の合併症のこともあるので注意が必要である。
  1. 詳細な病歴聴取と身体診察で筋肉痛の原因をある程度絞り込むことができる。
  1. 筋原性疾患や筋炎の鑑別が重要となる。これらは筋肉痛を引き起こすことがあるが、筋肉痛を訴える人のほとんどはこれらの疾患ではない。
 
  1. 多発性筋炎では悪性腫瘍の合併に注意が必要である(推奨度1M)。(参考文献:[1]
  1. 特に40歳代以上での発症の多発性筋炎では悪性疾患の合併が多く、腫瘍の検索が必要とされている。各種の悪性腫瘍がみられるが、頻度として多いのは、卵巣、乳腺、肺、胃、結腸直腸の癌、悪性リンパ腫である。東洋人では鼻咽頭領域や肺の癌が多いとの報告もある。
問診・診察のポイント  
 
  1. 詳細な病歴聴取は多くの鑑別疾患を絞り込むのに有用である。特に発症:突然か徐々か、痛みの場所、随伴症状:発赤や腫脹、熱感の有無、関連症状:便秘・うつ症状・体重変化・皮疹・知覚異常・嘔吐下痢などを聴取する。

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文献 

著者: Zaki Abou Zahr, Alan N Baer
雑誌名: Curr Rheumatol Rep. 2011 Jun;13(3):208-15. doi: 10.1007/s11926-011-0169-7.
Abstract/Text Dermatomyositis is associated with an underlying malignancy in about 24% of cases. This association is also true for polymyositis but is less prominent. The malignancy is usually an adenocarcinoma of the ovary, lung, or gastrointestinal tract in Western countries and nasopharyngeal carcinoma in Southeast Asia, Southern China, and Northern Africa. Factors predictive of malignancy in myositis patients include more severe skin and muscle disease and the absence of overlap connective tissue disease features, such as interstitial lung disease. Anti-p155/140 antibodies have a strong predictive value for malignancy in adult patients. Patients with dermatomyositis or polymyositis require an evaluation for occult malignancy at the time of diagnosis and, in some cases, in the event of a subsequent recurrence. This paraneoplastic phenomenon may stem from an immune reaction to antigens expressed in both cancer cells and regenerating fibers in affected muscle.

PMID 21336621  Curr Rheumatol Rep. 2011 Jun;13(3):208-15. doi: 10.1007・・・
著者: A D Woolf, G V Campion, A Chishick, S Wise, B J Cohen, P T Klouda, O Caul, P A Dieppe
雑誌名: Arch Intern Med. 1989 May;149(5):1153-6.
Abstract/Text Human parvovirus B19 has been associated with various clinical effects in a number of uncontrolled reports. To define the usual manifestations of B19 infection in adults and the factors that influence them we present a clinicoepidemiological study of an outbreak of B19 infection centered on a junior school. Four hundred fifty-three of 475 adults in this community were interviewed and blood was obtained for serological diagnosis. Fifty-four cases of recent infection were identified and were HLA typed. Fourteen of the cases were asymptomatic; 32 had an influenzalike illness; 23 a rash; and 26 an acute-onset polyarthropathy that was more common in women and lasted for up to 7 months. HLA-A, -B, and -C antigen frequencies were similar to a local control population and showed no association with symptoms except that HLA-DR1 was absent in those with persistent arthropathy.

PMID 2541666  Arch Intern Med. 1989 May;149(5):1153-6.
著者: Hitoshi Hayakawa, Mitsutoshi Tara, Kiyoshige Niina, Mitsuhiro Osame
雑誌名: Intern Med. 2002 Apr;41(4):295-9.
Abstract/Text OBJECTIVE: We investigated the clinical aspects of adult human parvovirus (HPV) B19 infection.
PATIENTS AND METHODS: We retrospectively reviewed the charts of 21 consecutive patients [4 males, aged 32 to 43 years (average 38.0 years), and 17 females, aged 15 to 43 (average 34.2)] with adult HPV B19 infection who visited our outpatient department between July 1997 and June 1998. All diagnoses of adult HPV B19 infection were based on positive anti-HPV B19 IgM antibody in serum and/or positive HPV B19 DNA in peripheral blood.
RESULTS: The predominant signs and symptoms of the patients were: fever (81.0%), arthralgia/myalgia (61.9%), skin rash (47.6%), general fatigue (42.9%), lymph node swelling (38.1%) and edema (38.1%). Six patients had the following underlying diseases or complications: pregnancy, myoma uteri, cervical cancer of the uterus, lupus diathesis/ endometriosis, hereditary spherocytosis, and multiple sclerosis. The following abnormal laboratory findings (more or less than normal limits) were observed: anemia (81.0%), leukopenia (33.3%), elevated transaminases (28.6%), and elevated lactate dehydrogenase (LDH) (57.1%). Six patients were considered to have persistent infection.
CONCLUSION: HPV B19 can infect healthy adults and causes more predominant signs and symptoms (arthralgia, myalgia and fever) than in children, and adult HPV B19 infection can be suspected from the familial history and clinical findings. Accordingly, more attention must be paid to adult HPV B19 infection, particularly when erythema infectiosum is prevalent in children.

PMID 11993790  Intern Med. 2002 Apr;41(4):295-9.
著者: Kazuhiro Waza, Kazuo Inoue, Shinji Matsumura
雑誌名: Intern Med. 2007;46(24):1975-8. Epub 2007 Dec 17.
Abstract/Text BACKGROUND AND OBJECTIVES: The clinical features of parvovirus B19 infection in adult patients have not been well described. The aim of this prospective study was to clarify the clinical features of adult patients with parvovirus B19 infection in primary care settings.
METHODS: The study subjects were adults over age 18 years who had visited one primary care clinic over a period of one year. They were chosen if they had at least two of the following three symptoms: edema, joint pain, and rash, and if they had contact with children with erythema infectiosum. The diagnosis was confirmed if anti-parvovirus B19 antibodies were identified. The process of these symptoms was recorded until they resolved.
RESULTS: Twenty patients met the inclusion criteria, and 14 (70%) patients were diagnosed with parvovirus B19 infection. The 14 adult patients consisted of two men and twelve women ranging from 33 to 63 years (median, 38 years). The patients consisted of two groups. In the first group, they presented with the first phase of infection showing symptoms such as malaise, muscle pain, and fever, and in the second phase presented with edema, rash, and joint pain that developed within two days of the first phase. In the second group, the first and second phases were clearly separated.
CONCLUSIONS: Parvovirus B19 infection in adults can be efficiently diagnosed in primary care settings by observing clinical symptoms such as edema, joint pain, and rash, and by asking patients about their contact with children who have erythema infectiosum.

PMID 18084119  Intern Med. 2007;46(24):1975-8. Epub 2007 Dec 17.
著者: J Veenstra, W M Smit, R T Krediet, L Arisz
雑誌名: Nephrol Dial Transplant. 1994;9(6):637-41.
Abstract/Text The incidence, causes and complications of severe rhabdomyolysis (creatine phosphokinase (CK) > or = 5000 U/l) were studied during a 7-year study period in a large university hospital population. This condition was present in 0.074% of all admitted patients. The mortality in the study group (n = 93) was 32% and the incidence of acute renal failure (ARF) 51%. Ischaemia was the most frequent cause, and drugs, alcohol and/or coma were the second most common cause of severe rhabdomyolysis. Patients with rhabdomyolysis due to ischaemia were older, had ARF more often, and also had the highest mortality. Hyperkalaemia (potassium > or = 5.5 mmol/l) occurred in 13% of the patients, and all of them had or developed an impaired renal function. Hypocalcaemia (calcium < or = 2.00 mmol/l) was found in 41%. The incidence of ARF and electrolyte disturbances was higher in patients with CK levels exceeding 15,000 U/l. Mortality was significantly higher in patients with ARF. Plasma concentrations of potassium and calcium correlated better with the severity of renal failure than with the maximal height of plasma CK.

PMID 7970089  Nephrol Dial Transplant. 1994;9(6):637-41.
著者: S C Curry, D Chang, D Connor
雑誌名: Ann Emerg Med. 1989 Oct;18(10):1068-84.
Abstract/Text
PMID 2679245  Ann Emerg Med. 1989 Oct;18(10):1068-84.
著者: B D Prendergast, C F George
雑誌名: Postgrad Med J. 1993 May;69(811):333-6.
Abstract/Text
PMID 8393995  Postgrad Med J. 1993 May;69(811):333-6.
著者: John M Sauret, George Marinides, Gordon K Wang
雑誌名: Am Fam Physician. 2002 Mar 1;65(5):907-12.
Abstract/Text Rhabdomyolysis is a potentially life-threatening syndrome resulting from the breakdown of skeletal muscle fibers with leakage of muscle contents into the circulation. The most common causes are crush injury, overexertion, alcohol abuse and certain medicines and toxic substances. Several inherited genetic disorders, such as McArdle's disease and Duchenne's muscular dystrophy, are predisposing factors for the syndrome. Clinical features are often nonspecific, and tea-colored urine is usually the first clue to the presence of rhabdomyolysis. Screening may be performed with a urine dipstick in combination with urine microscopy. A positive urine myoglobin test provides supportive evidence. Multiple complications can occur and are classified as early or late. Early complications include severe hyperkalemia that causes cardiac arrhythmia and arrest. The most serious late complication is acute renal failure, which occurs in approximately 15 percent of patients with the syndrome. Early recognition of rhabdomyolysis and prompt management of complications are crucial to a successful outcome.

PMID 11898964  Am Fam Physician. 2002 Mar 1;65(5):907-12.
著者: Ana L Huerta-Alardín, Joseph Varon, Paul E Marik
雑誌名: Crit Care. 2005 Apr;9(2):158-69. doi: 10.1186/cc2978. Epub 2004 Oct 20.
Abstract/Text Rhabdomyolysis ranges from an asymptomatic illness with elevation in the creatine kinase level to a life-threatening condition associated with extreme elevations in creatine kinase, electrolyte imbalances, acute renal failure and disseminated intravascular coagulation. Muscular trauma is the most common cause of rhabdomyolysis. Less common causes include muscle enzyme deficiencies, electrolyte abnormalities, infectious causes, drugs, toxins and endocrinopathies. Weakness, myalgia and tea-colored urine are the main clinical manifestations. The most sensitive laboratory finding of muscle injury is an elevated plasma creatine kinase level. The management of patients with rhabdomyolysis includes early vigorous hydration.

PMID 15774072  Crit Care. 2005 Apr;9(2):158-69. doi: 10.1186/cc2978. E・・・
著者: Noboru Takayanagi, Daidou Tokunaga, Motoko Kubota, Kenichirou Hara, Hiroo Saito, Mikio Ubukata, Kazuyoshi Kurashima, Tsutomu Yanagisawa, Yutaka Sugita
雑誌名: Nihon Kokyuki Gakkai Zasshi. 2005 Dec;43(12):731-5.
Abstract/Text We assessed the frequency and etiology of rhabdomyolysis in patients with community-acquired pneumonia. In 594 patients with community-acquired pneumonia whose serum CPK were measured, 25 patients (2.4%) were found to have rhabdomyolysis. Including 4 patients with mixed infections, the etiologies in 25 patients with community-acquired pneumonia with rhabdomyolysis were as follows: Legionella species, 11 patients (44%); Influenza virus, 6 (24%); Streptococcus pneumoniae, 4 (16%); Chlamydia psittaci, 3 (12%); Mycoplasma pneumoniae, 2 (8%); unknown 3 patients (12%). The rates of rhabdomyolysis for each etiologic category were as follows: Legionella species, 26.8% (11/41); Chlamydia psittaci, 21.4% (3/14); Influenza virus, 9.5% (6/63) ; Streptococcus pneumoniae, 4.7% (4/85);Mycoplasma pneumoniae, 3.1% (2/65). Renal dysfunction with a serum creatinine concentration greater than 1.5 mg/dl occurred in 6 patients (24%). Our experience illustrates that 5 pathogens can cause rhabdomyolysis in patients with community-acquired pneumonia. Legionella species are the most common organisms followed by Influenza virus, Streptococcus pneumoniae, Chlamydia psittaci, Mycoplasma pneumoniae.

PMID 16457334  Nihon Kokyuki Gakkai Zasshi. 2005 Dec;43(12):731-5.
著者: M Lopez-Hoyos, C Ruiz de Alegria, R Blanco, J Crespo, M Peña, V Rodriguez-Valverde, V M Martinez-Taboada
雑誌名: Rheumatology (Oxford). 2004 May;43(5):655-7. doi: 10.1093/rheumatology/keh143. Epub 2004 Feb 17.
Abstract/Text BACKGROUND: In a significant number of patients the differential diagnosis between elderly-onset rheumatoid arthritis (EORA) and polymyalgia rheumatica (PMR) is very difficult because of the lack of specific serum markers. Anti-cyclic citrullinated peptide antibodies (anti-CCP Abs) have recently been shown to be highly specific for rheumatoid arthritis (RA). This is the first study addressing the utility of these antibodies in the differential diagnosis between EORA and PMR.
METHODS: Serum samples from 57 EORA patients and 49 PMR patients were studied for the presence of anti-CCP Abs and rheumatoid factor (RF). As controls, samples from 41 RA patients (age at onset <60 yr) and 24 aged healthy subjects were analysed.
RESULTS: Sixty-five per cent of EORA patients had anti-CCP Abs, whereas none of the PMR patients or the aged healthy subjects was positive for those antibodies. Ten of the EORA patients started with polymyalgic symptoms and two of them were positive for anti-CCP Abs. Interestingly, there was a significant correlation between anti-CCP Abs and RF in EORA but not in young RA patients.
CONCLUSIONS: The presence of anti-CCP Abs in a patient with clinical symptoms of PMR must be interpreted as highly suggestive of EORA.

PMID 14970400  Rheumatology (Oxford). 2004 May;43(5):655-7. doi: 10.10・・・
著者: Yoko Aoki, Masahiro Iwamoto, Seiji Minota
雑誌名: Nihon Rinsho Meneki Gakkai Kaishi. 2009 Aug;32(4):274-8.
Abstract/Text Polymyalgia rheumatica (PMR) is an inflammatory disease of unknown etiology affecting elderly patients and characterized by muscle pain and morning stiffness in proximal areas (pelvic and shoulder girdles and neck). It is sometimes difficult to distinguish PMR from rheumatoid arthritis (RA), or vasculitis. In the present study, we examined the clinical characteristics of the patients diagnosed with PMR in our hospital retrospectively. There were 44 patients with the median age of 71s. Eighty percent of the patients were in their 60s or 70s, and 3 patients (6.8%) were in there 50s or younger. There was no sex preponderance in frequency. Fifteen patients (34%) presented with both proximal and distal muscle pain. Arthritis occurred in 16 patients (36%), the half of which was monarthritis or oligoarthritis, and was more involved in wrist or knee joint. Only 3 patients had temporal arteritis (TA) complicated with PMR. Mean of maximum serum CRP was 8.18 mg/dl, and rheumatoid factor and anti-CCP antibodies were positive in 2 patients and a patient, respectively. There was no patient positive for ANCA. Serum MMP-3 levels tended to be higher in female patients. Median of maximum prednisolone (PSL) dose used for the treatment was 0.195 mg/kg of body weight daily. No patient needed any immunosuppressants. In the 26 patients we had a chance to follow, there were no patients who developed RA 6 months after the initial diagnosis. Progression from PMR to RA was reported, and mean period between the diagnosis of PMR and RA was one to 5 years.

PMID 19721349  Nihon Rinsho Meneki Gakkai Kaishi. 2009 Aug;32(4):274-8・・・
著者: Clement J Michet, Eric L Matteson
雑誌名: BMJ. 2008 Apr 5;336(7647):765-9. doi: 10.1136/bmj.39514.653588.80.
Abstract/Text
PMID 18390527  BMJ. 2008 Apr 5;336(7647):765-9. doi: 10.1136/bmj.39514・・・
著者: C L Teh, J S Wong, H H Soo
雑誌名: Rheumatol Int. 2012 Jan;32(1):265-8. doi: 10.1007/s00296-010-1745-2. Epub 2011 Jan 18.
Abstract/Text We performed a cross-sectional study of the demography, clinical and laboratory features of patients with polymyositis and dermatomyositis followed up in our centre from 2006 to 2009. There were 12 cases, with the majority of them (58.3%) being woman. They have a mean age of 57.8 years and mean disease duration of 11.83 (SD 9.92) months. Our patients comprised of multi-ethnic groups with predominantly Chinese (83.3%), Sarawak natives (8.3%) and Malays (8.3%). They have a mean lag time to diagnosis of 3.67 (SD 4.27) months. Nine (75%) patients had dermatomyositis and 3(25%) had polymyositis. The common clinical manifestations found in our patients were proximal myopathy (100%), neck weakness (33.3%), dysphagia (33.3%) and interstitial lung disease (33.3%). For the nine patients with dermatomyositis, the most common dermatological manifestations were shawl sign (88.9%) and V sign (88.9%). Muscle enzymes were raised in 91.7% of patients. Electromyographies were carried out in four patients, and only one of our patients had muscle biopsy. Only 41.7% of our patients have positive ANA. The majority received prednisolone (100%) and hydroxychloroquine (58.3%). Malignancy occurred in five (three nasopharyngeal carcinomas, one sigmoid colon cancer and one lung cancer) out of the nine dermatomyositis patients but none in the polymyositis group. The mortality rate in our group was 4(33.3%) over the 4-year period. This study demonstrated the rarity of PM/DM in our centre with considerable lag time to diagnosis in our patients. Despite lack of muscle biopsy in our centre, our centre achieved appropriate diagnosis and management of PM/DM.

PMID 21243497  Rheumatol Int. 2012 Jan;32(1):265-8. doi: 10.1007/s0029・・・
著者: Carlo Salvarani, Fabrizio Cantini, Gene G Hunder
雑誌名: Lancet. 2008 Jul 19;372(9634):234-45. doi: 10.1016/S0140-6736(08)61077-6.
Abstract/Text Polymyalgia rheumatica and giant-cell arteritis are closely related disorders that affect people of middle age and older. They frequently occur together. Both are syndromes of unknown cause, but genetic and environmental factors might have a role in their pathogenesis. The symptoms of polymyalgia rheumatica seem to be related to synovitis of proximal joints and extra-articular synovial structures. Giant-cell arteritis primarily affects the aorta and its extracranial branches. The clinical findings in giant-cell arteritis are broad, but commonly include visual loss, headache, scalp tenderness, jaw claudication, cerebrovascular accidents, aortic arch syndrome, thoracic aorta aneurysm, and dissection. Glucocorticosteroids are the cornerstone of treatment of both polymyalgia rheumatica and giant-cell arteritis. Some patients have a chronic course and might need glucocorticosteroids for several years. Adverse events of glucocorticosteroids affect more than 50% of patients. Trials of steroid-sparing drugs have yielded conflicting results. A greater understanding of the molecular mechanisms involved in the pathogenesis should provide new targets for therapy.

PMID 18640460  Lancet. 2008 Jul 19;372(9634):234-45. doi: 10.1016/S014・・・
著者: R C Brooks, S R McGee
雑誌名: Arch Intern Med. 1997 Jan 27;157(2):162-8.
Abstract/Text Polymyalgia rheumatica is a clinical syndrome of proximal muscle pain in older patients that often presents a diagnostic challenge because of the large differential diagnosis, lack of definitive diagnostic criteria, and relatively frequent "atypical" clinical findings, such as peripheral synovitis, distal extremity pain, normal erythrocyte sedimentation rate, and mild weakness. Despite an extensive differential diagnosis that includes endocarditis and steroid-responsive malignant neoplasms, routine laboratory testing should be limited, and a low-dose corticosteroid trial is useful as the final step in the evaluation. The clinical overlap with seronegative rheumatoid arthritis is striking, suggesting that these diagnoses may represent different presentations of a similar disease process. While concurrent asymptomatic temporal arteritis is common, there are no data to support obtaining a temporal artery biopsy in patients with pure polymyalgia rheumatica symptoms.

PMID 9009973  Arch Intern Med. 1997 Jan 27;157(2):162-8.
著者: K Mizuta, T Yamakawa, K Kurokawa, S Chikaoka, Y Shimizu, T Itagaki, F Katsushima, Y Katsushima, S Ito, Y Aoki, Y Matoba, S Tanaka, K Yahagi
雑誌名: Epidemiol Infect. 2016 Apr;144(6):1286-90. doi: 10.1017/S0950268815002873. Epub 2015 Nov 20.
Abstract/Text We previously reported an association between human parechovirus type 3 (HPeV3) and epidemic myalgia with myositis in adults during summers in which an HPeV3 outbreak occurred in children. However, this disease association has not yet been reported elsewhere. We have since continued our surveillance to accumulate data on this disease association and to confirm whether myalgia occurs in children as well as adults. Between June and August 2014, we collected 380 specimens from children with infectious diseases. We also collected clinical specimens from two adult and three paediatric patients suspected of myalgia. We then performed virus isolation and reverse-transcription-PCR using the collected specimens. We detected HPeV3 in 26 children with infectious diseases, which we regarded as indicating an outbreak. We also confirmed HPeV3 infection in all patients suspected of myalgia. In particular the symptoms in two boys, complaining of myalgia and fever, closely matched the criteria for adult myalgia. Based on our findings from 2008, 2011 and 2014, we again urge that clinical consideration be given to the relationship between myalgia and HPeV3 infections during HPeV3 outbreaks in children. Furthermore, our observations from 2014 suggest that epidemic myalgia and myositis occur not only in adults but also in children.

PMID 26584624  Epidemiol Infect. 2016 Apr;144(6):1286-90. doi: 10.1017・・・
著者: Tatsushi Yamakawa, Katsumi Mizuta, Katsurou Kurokawa, Hikaru Nagasawa, Takahiro Yamada, Emiko Suzuki, Manabu Wada
雑誌名: Rinsho Shinkeigaku. 2017 Sep 30;57(9):485-491. doi: 10.5692/clinicalneurol.cn-001035. Epub 2017 Aug 31.
Abstract/Text We investigated 17 adult cases (14 males and 3 females) of myalgia induced by human parechovirus type 3 (HPeV3) infection, treated during the summers of 2008, 2011, 2014, and 2016. The patients were aged between 21 and 50 years. The limbs and trunk of all patients were affected, and severe myalgia, muscle weakness, and decreased grip strength were observed. In addition to myalgia and muscle weakness, symptoms included fever in 14 (82%), upper respiratory inflammation in 8 (47%), gastroenteritis in 4 (24%), and scrotal pain in 4 (29% of males) patients. Tendon reflexes were preserved, and serum creatine kinase level increased in all but 1 patient. Spinal MRI was performed for 3 patients, with normal results. Musculoskeletal MRI scans showed abnormal signals in the femoral muscles in 2 of 5 patients. In a nerve conduction test, the frequency of F wave appearance in the median nerve was 40% or less in 5 of 9 patients, and repeater F waves were seen in 2 patients. Of these, 7 patients had infants in their families, and developed fever around the same time; they may have been infected by these infants. All patients recovered within 1-2 weeks. HPeV3 infection is characterized by severe myalgia, and is frequently observed in summer every 2-3 years.

PMID 28855493  Rinsho Shinkeigaku. 2017 Sep 30;57(9):485-491. doi: 10.・・・

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