The manifestation of myositis in tick-borne encephalitis as a prophet of severe disease course: a rare case report.

Tick-borne encephalitis (TBE) is one of the most serious neurological tick-transmitted diseases. The initial phase usually occurs with non-specific symptoms such as fever, headache, and muscular pain. The clinical spectrum of the second phase of the disease typically ranges from mild meningitis to severe meningoencephalitis. Our case demonstrates a rare clinical case of acute myositis as manifestation of TBE virus infection. A 33-year-old female was admitted to the Rheumatology centre with a fever followed by proximal muscle pain and weakness. Despite the tick bite history and marginally positive anti-TBE virus IgM titre, the patient did not present any neurological symptoms. Laboratory test results showed elevated creatine kinase (CK) and myoglobin. Other infections, idiopathic inflammatory myopathies, were excluded. TBE virus infection was confirmed by rapid seroconversion of specific IgG class antibodies in serum. The second phase of the disease was followed by neurological symptoms and a repeated increase of CK and myoglobin. We suggest that in the case of acute myositis of unknown cause and the history of thick bite, TBE virus infection should be considered and creatine kinase might be considered as a laboratory marker of disease activity that correlates with the severity of the disease.

Power Doppler artifacts in evaluating inflammatory arthritis of small joints: comparison with a superb microvascular imaging technique.

Conventional Doppler techniques provide clinical information about tissue vascularisation, but they have limitations in detecting low-velocity blood flow. The innovative Doppler technique called superb microvascular imaging provides visualization of microvascular flow never seen before with the ultrasound. The new tool suppresses the noise caused by motion artifacts with an innovative filter system without removing the weak signal arising from small vessel flow, hence it achieves a greater sensitivity than power Doppler. Explanation of motion artifact genesis reveals SMI imaging principles and helps to distinguish false-positive results. Due to the higher SMI sensitivity to flow, there are nuances in the interpretation of other artifacts as well as motion. The paper presents commonly encountered artifacts of power Doppler compared with a novel microvascular imaging technique focused on a small joints inflammation. The main attention is intent on the practical recommendations for ultrasound machine settings and evaluation of comparable images.