Article: article from journal or magazin.
Case report (case report): feedback on an observation with a short commentary.
Eosinophilic perimyositis as the presenting feature of a monoclonal T-cell expansion
Muscle and Nerve
Case Reports Journal Article --- Old month value: May
A 51-year-old physically active man was investigated for exertional myalgias and muscle stiffness. On examination he had mild proximal muscle weakness of the upper extremities and retraction of the digit flexors. Blood eosinophilia was present, but serum creatine kinase (CK) levels and an electromyographic study were normal. A skin-fascia-muscle biopsy of the calf revealed a macrophagic and CD4+ T-cell infiltration of the perimysium, and a T-cell expansion was observed in blood, bone marrow, and muscle. A diagnosis of eosinophilic perimyositis was made, and prednisone and azathioprine were administrated with a good clinical response. This case highlights the differential diagnosis of blood eosinophilia with muscle disorders, and underscores that eosinophilic perimyositis may be the expression of a T-cell monoclonal expansion. Although the pathogenesis behind the T-cell expansion is unclear but probably inflammatory, we suggest regular follow-up to allow early treatment of any T-cell lymphoproliferative malignancy that may develop.
Arm/physiopathology CD4-Positive T-Lymphocytes/pathology Clone Cells/immunology/pathology Diagnosis, Differential Eosinophilia-Myalgia Syndrome/etiology/pathology/*physiopathology Eosinophils/pathology Humans Lymphoproliferative Disorders/*complications/diagnosis/physiopathology Macrophages/pathology Male Middle Aged Muscle Weakness/etiology/pathology/physiopathology Muscle, Skeletal/pathology/*physiopathology Myositis/etiology/pathology/*physiopathology T-Lymphocytes/immunology/*pathology
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