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Acute Myositis as an Unusual Presentation of Wegener's Granulomatosis

Dwayne T. Shuhart, MD; Dennis J. Torretti, MD; Janis F. Maksimak, MD; Stephen George, MD
Arch Pediatr Adolesc Med. 1994;148(8):875-876. doi:10.1001/archpedi.1994.02170080105021.
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Wegener's granulomatosis (WG) is a necrotizing granulomatous vasculitis of small arteries and veins typically involving the respiratory tract and kidneys.1 The disease is uncommon in adults and is rarely diagnosed in the pediatric population.

The clinical presentation typically involves the lungs, kidneys, nasopharynx, and paranasal sinuses.2 Patients often present with recurrent otitis and sinusitis, pulmonary infiltrates, arthralgias, and myalgias.1 The diagnosis in children may be delayed because of its relative rarity or failure to recognize its varied clinical manifestations.3-7 We recently evaluated and treated a patient with WG who presented with severe myalgias, elevated creatinine phosphokinase (CPK) levels, and histologic evidence of acute myonecrosis.

Patient Report. Severe lower-extremity myalgias and low back pain developed in a 14-year-old girl that impaired her ambulation. Three weeks previously, the patient was treated for serous otitis media, otalgia, and streptococcal pharyngitis. Myalgias began soon after the pharyngitis had subsided. Subsequently,


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