P35 Case description of myositis-peritonitis(fasciitis) in a 4 year old female toddler who was hospitalised in our clinic

Background Myofasciitis is a rare disease of the muscles and its fascia, which is most common in adults and is very rarely found in children. Aim Description of a case of myositis-peritonitis(fasciitis) in a 4 year old female toddler and arise the awareness of the hospital and general paediatrician for the clinical presentation of this rare disease. Method-material-case description In November of 2016 a 4 year old toddler of greek origin from the state of Magnesia, Greece, was admitted to the emergency department of our hospital. The toddler presented claudication 12 hours prior to the admission and symptoms of upper and lower respiratory tract infection with cough from several days. At the admission the toddler presented claudication, limitation of the active and passive motility of both hips, especially the right, limited motility of the truncus and limbs, swelling of right cheek and right temple. Imaging studies revealed swelling of the soft tissues around the right hip joint and swelling of multiple intra-parotid and neck lymph nodes. The blood examination at the admission revealed leukocytosis, mild increase of the indicators of inflammation, of creatine phosphokinase (CPK) and increased coagulation time. Because of the clinical picture of the patient intravenous antibiotics were givenB(ceftriaxone and clindamycin).The differential diagnosis included myositis, fasciitis, septic arthritis of right hip joint and invasive general microbe infection. Results Because of the rapid deterioration of the clinical and laboratory picture in the next 12 hours (further increase of CPK, indicators of inflammation) the toddler was transferred to a tertiary Hospital of Athens. The imaging studies revealed a consolidation of the basis of the right lung and mild consolidation behind the heart. The MRI revealed swelling and inflammation of the majority of the muscles of the haunches, the thighs (especially the right), swelling of the subcutaneous tissue of both haunches and its fascias. The clinical and imaging picture was compatible with myofasciitis. The general status of the patient was improved and the antibiotic therapy was continued for 14 days in total. The metabolic and rheumatologic results are still pending. Conclusions The data in literature for myofasiitis are not enough but we believe that it is localised histological inflammation that may be caused by a previous immunisation with alluminium adjuvants contained vaccines, rather than a primary inflammatory muscle disease. The histological hallmark of myofasciitis is the infiltration of the muscle and its fascia by macrophage cells. The symptoms include joint pain, muscle weakness, fatigue, fever and pain on the palpation of the muscles.