Abstract
Introduction: Focal myositis is a rare idiopathic pseudotumor that occurs mostly in adults. It is generally located in the extremities. In literature only two cases of focal myositis in the cervical region in childhood have been described. Focal myositis can be hard to distinguish from infectious and malignant disease as illustrated by this case report. Case description: An 8 year old boy presented to the emergency department with a few months history of a cervical tumor that was increasing in size and with fever. Blood inflammatory parameters were elevated (C-reactive protein 64 mg/l, leukocyte number 17,7 x 109/L) and ultrasound investigation revealed an inhomogeneous mass consistent with infectious lymphadenitis. Amoxicillin/clavulanic acid per os was prescribed. After four days of treatment antibiotics were continued intravenously as there was no symptomatic improvement. After nine days of treatment the clinical picture was unchanged. MRI imaging revealed continuity of the tumor with the musculus sternocleidomastoideus and a malignant process was suspected. Microscopy showed no malignant cells however, but a lymphoplasmocytic infiltrate with fibrosis and degeneration of muscle fibres, consistent with focal myositis. No intervention was undertaken and one year after presentation the tumor had regressed almost entirely. Conclusion: Focal myositis is a rare cause of cervical tumor in children. Typically, focal myositis presents as a nodule located in an extremity. Focal myositis in the cervical region can be hard to distinguish from infectious lymphadenitis. In case of insufficient response to empirical antibiotic therapy for suspected lymphadenitis focal myositis should thus be considered as alternative diagnosis. Continuity of tumorous tissue with the underlying structure is an essential feature of focal myositis that allows differentiation from lymphadenitis. This can however not always be identified using ultrasound investigations. MRI imaging allows more accurate characterisation of tumor properties. Focal myositis is diagnosed based upon histological examination of a biopsy. Microscopically it is characterized by infiltrating lymphocytes, fibroblast proliferation with fibrosis and degeneration of muscle fibers. Focal myositis regresses spontaneously. Treatment consists of analgesics and surgical intervention is usually not indicated.
Translated title of the contribution | A boy with cervical focal myositis |
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Original language | Dutch |
Pages (from-to) | A6935 |
Journal | Nederlands Tijdschrift voor Geneeskunde |
Volume | 158 |
Issue number | 18 |
Publication status | Published - 2014 |
Keywords
- Cervical Vertebrae/pathology
- Child
- Edema/pathology
- Fever/pathology
- Humans
- Magnetic Resonance Imaging
- Male
- Myositis/diagnosis
- Neck Muscles/pathology
- Spinal Neoplasms/diagnosis