CLINICAL MEET

MAY, 2021
WARD 15.
12 years old , girl, 1st by birth order, BONCM, was admitted with the
complaints of -

• Fever, on and off, since 2 months.

• Swelling and pain over the joints since 2 months

• Started from wrist joint and then progressed to involve all the large joints.

• Pain over the thighs, calf muscles and back since 2 months.

Associated with inability to perform activities of daily living.

• Difficulty in climbing upstairs, getting up from supine and sitting position,

raise her arms above shoulder.
• Rash over the chest noticed since 15 days.

• Difficulty in swallowing since 15 days.

PAST HISTORY:
• H/O hospital admission in October, 2020 with C/O-
-Weakness of all the limbs since 1.5 months,
(Proximal > Distal)
- Generalized bodyache since 1.5 months.
- No h/s/o preceeding illness, fever, joint pain, sensory abnormality,

and rash.
• Child was investigated for the same.
INVESTIGATIONS-
CBC INFLAMMATORY BIOCHEMISTRY
MARKERS
HB- 12.1 ESR- 90 RFT- NORMAL URINE R/M- ANA BLOT-
NORMAL NEGATIVE.

TLC- 7700 CRP- 14 SGOT- 478 OPHTHALM-

NORMAL
58/37/4/1 SGPT- 192 2D ECHO-
NORMAL
3.4 LACS CPK- 13362.8
CPK-MB- 1189.2

URIC ACID- 4.8

MYOSITIS PANEL: Mi-2β strongly positive
(2+)
MRI DORSAL SPINE WITH WSS

• Diffuse edema in paraspinal muscles of the cervical, dorsal and

lumbar region and in the scapular region. S/O inflammatory myositis.
MRI
MUSCLE BIOPSY OF PARASPINAL
MUSCLE:
• Focal areas of necrosis of muscle fibres seen.
• Focal phagocytosis is seen with collection of phagocytic cells.
• Increase in endomyceal and perimyceal connective tissue.
• Features suggestive of inflammatory myopathy.
TREATMENT RECEIVED:
• Pulse dose MPS given f/b Oral steroids.
• Methotrexate 2.5mg once a week @5mg/m2
• Calcium and vitamin D supplements.
• ANTENATAL AND BIRTH HISTORY- Not contributory.

• DEVELOPMENTAL HISTORY- Appropriate for age.

• Immunised till 5 years of age.

• NUTRITION- Appropriate.

• FAMILY HISTORY- Not contributory.

ON EXAMINATION-
• GENERAL EXAMINATION:
Haemodynamically - Stable.
• No pallor, lymphadenopathy, or oedema.
• Anthropometry-
OBSERVED EXPECTED

WEIGHT 27 kg 29 KG

HEIGHT 139 cm 140 CM

BMI 14 17.9
HEAD TO TOE
EXAMINATION-

HELIOTROPE RASH
MALAR RASH
MUSCULOSKELETAL EXAMINATION-
• Paediatric Gait, Arms, Legs, Spine screen (pGALS)-
Pain in bilateral shoulder joints on outstretching hands anteriorly, lifting
above shoulder.
Difficulty in bending forwards.
Restriction of active and passive movements of the knee.
Tenderness over bilateral sacroiliac joints.
• Calf and thigh tenderness.
• Swelling over the PIP joints of hands, no inflammation.
• Respiratory system-
Single breath count- 14.
Tenderness present in bilateral lower chest wall.
• CNS-
Difficulty in lifting her arms above shoulder.
Gower’s sign positive.
• Rest S/E- WNL.
TREATMENT-
• Started on Inj. Methylprednisolone for 3 days.

• F/B oral steroids, 2 mg/kg/day.

• Methotrexate, 20 mg/m2/wk sc..

• Folic acid, calcium supplements.

• Sunscreen lotion.