Adolescente con fiebre y dolor torácico. El abordaje de siempre; pero lo ya conocido a veces sorprende / Adolescent with fever and chest pain. The usual approach; but what is already known sometimes surprises

El dolor torácico en Pediatría es un síntoma común que puede suponer ingresos hospitalarios y derivaciones a especialistas. La etiología cardíaca es la responsable en una minoría de los casos, aunque es una de las que más preocupa al paciente y a sus familias. El dolor torácico agudo es un síndrome clínico que puede ser causado por casi cualquier condición que afecte al tórax, al abdomen o a los órganos internos. En ocasiones, este extenso y costoso trabajo de diagnóstico puede ser evitado teniendo en cuenta las causas más comunes y no graves. Se comenta el caso de un niño con la enfermedad de Bornholm secundaria a la infección por enterovirus (AU)

Chest pain in Paediatrics is a common symptom culminating in hospital admissions and specialist referrals. Cardiac etiology is found to be the culprit in minority of the cases. Acute chest pain is a clinical syndrome that may be caused by almost any condition affecting the thorax, abdomen, or internal organs. On occasions this extensive and expensive diagnostic work up can be avoided with awareness of commoner and non-severe reasons. We report a case of a child with Bornholm disease secondary to enterovirus infection. (AU)

Clinical Characteristics of Epidemic Myalgia Associated with Human Parechovirus Type 3 during the Summer of 2019.

Objective Epidemic myalgia associated with human parechovirus type 3 (EM-HPeV3) is characterized by severe muscle pain and weakness on the limbs and trunk with a fever. No outbreak of EM-HPeV3 has been reported since 2016, and its clinical characteristics have not been sufficiently clarified. We herein report a series of EM-HPeV3 cases during the summer of 2019 and clarify the clinical characteristics of EM-HPeV3. Methods The diagnosis of EM-HPeV3 was established when the patients met both of the following criteria: (1) Patients developed severe muscle pain and weakness with a fever within a week, and those symptoms resolved within a month; and (2) HPeV3 was detected in either a throat swab or fecal specimen of the patient by polymerase chain reaction. We reviewed the medical records of these patients retrospectively. Results Seven patients met the criteria (6 men and 1 woman, age 34 to 47 years old). Myalgia was observed on the thigh, lower legs, upper arms, and forearms in seven, five, two, and five patients, respectively. Four patients showed distal dominant weakness on the arms, while none of the patients showed proximal dominant weakness on the arms. Of the six patients examined, five showed reduced tendon reflexes on all four limbs. One patient showed slight myogenic change and increased insertion activities on needle electromyography. Conclusion We observed seven cases of EM-HPeV3 during the summer of 2019. Reduced tendon reflexes and distal dominancy of muscle pain and weakness on the arms are considered its distinct clinical features.

Severe epidemic myalgia with an elevated level of serum interleukin-6 caused by human parechovirus type 3: a case report and brief review of the literature.

BACKGROUND: Human parechovirus type 3 (HPeV-3) is known to cause cold-like symptoms, diarrhea, or severe infections such as sepsis in infants and children. In adults, HPeV-3 infection is rarely diagnosed because the symptoms are generally mild and self-limiting; however, this infection has been linked to epidemic myalgia, regardless of the presence of underlying diseases, immunosuppression, or sex. CASE PRESENTATION: We describe an adult case of severe systemic myalgia and orchiodynia after infection with HPeV-3, which was transmitted from the child of the patient. Interleukin-6 (IL-6) level was found to be elevated in the patient's serum. CONCLUSION: Severe myalgia associated with HPeV-3 infection is potentially caused by an elevated serum level of IL-6.

Clinical characteristics of 17 adult patients with epidemic myalgia associated with human parechovirus type 3 infection.

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.

A case of epidemic myalgia with symptoms resembling acute purulent spondylitis and discitis.

BACKGROUND: Epidemic myalgia is a disease that presents with fever and extreme myalgia of the trunk due to an acute enterovirus infection. The trunk pain is mainly in the chest or in the epigastrium. We aimed to highlight a case of epidemic myalgia where initial diagnosis needed differentiation from acute purulent spondylitis and discitis. CASE PRESENTATION: A 33-year-old woman presented with fever, chills, and acute episodes of low back pain. The sole unusual finding was pain upon spinal percussion, limited to the 4th and 5th lumbar vertebrae. Spinal MRI showed no abnormality. Paired serum samples from disease days 4 and 15 showed a significant increase in coxsackievirus B3-neutralizing antibodies. Based on this course, we diagnosed epidemic myalgia. CONCLUSIONS: Epidemic myalgia should be considered when differentiating acute low back pain accompanied by fever.

Epidemic myalgia and myositis associated with human parechovirus type 3 infections occur not only in adults but also in children: findings in Yamagata, Japan, 2014.

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.

Chest wall myositis in a patient with acute coronary syndrome.

We describe a case of a 42-year-old man who presented to the emergency department with severe left-sided chest pain and chest tenderness of 1-day duration. The pain was episodic and was aggravated by any chest wall movement. His initial blood tests and ECG were suggestive of acute coronary syndrome (ACS). However, his pattern of pain, lack of response to opiates, raised creatine kinase and signs of pleurisy on chest radiograph raised a suspicion of an alternative diagnosis. The patient showed a dramatic response in pain relief to non-steroidal anti-inflammatory medication. He was suspected to have chest wall myositis with pleural involvement in the form of pleurodynia. His serology test was positive for coxsackie virus antibodies. We will discuss in this case report the pathognomonic features, diagnosis and treatment of a rare infectious condition known as Bornholm disease.

Pleurodynia caused by an echovirus 1 brought back from the tropics.

A 31 year-old woman presented with acute pain on the left side of the thorax and abdomen, radiating to the back together with fever, after she had returned from traveling in Southeast Asia. Except for pleural friction rub auscultated on the left hemithorax, no physical abnormalities were detected. We diagnosed a classical course of Bornholm disease, caused by an echovirus type 1. While described as a classical pathogen causing Bornholm disease, this genotype has not been reported frequently in Surveillance data in the Western World.

Epidemic pleurodynia caused by coxsackievirus B3 at a medical center in northern Taiwan.

Epidemic pleurodynia is seldom reported in Southeast Asia and there has been no report from Taiwan. We conducted a retrospective chart review of children = 18 years of age in the National Taiwan University Hospital from January 1 to December 31, 2005. Epidemic pleurodynia was defined as an acute illness characterized by sharp localized pain over the chest or upper abdomen. Patients with known heart diseases or pulmonary consolidations were excluded. In total, 28 patients met the case definition of epidemic pleurodynia. Coxsackievirus B3 (CB3) was isolated in 15 (60%) of the 25 throat swab specimens. Four (14%) of the 28 patients presented chest wall tenderness and only one (6%) of the 18 patients tested had an elevated creatinine kinase level. Twenty-one (75%) of the 28 patients described pleuritic chest pains and 10 (45%) of the 22 chest radiographies exhibited pulmonary infiltrates or pleural effusions. Six patients were observed with tonsillar exudates and one was confirmed to have a CB3 urinary tract infection. The clinical features and radiological findings suggest that CB3-associated epidemic pleurodynia might be a disease of the pleura and occasionally spreads to nearby tissues, resulting in chest wall myositis, pulmonary infiltrates and myopericarditis.