Abstract
Localized nodular myositis (LNM) is a rare variant of polymyositis beginning with inflammatory nodules within muscles.
Only seven cases have so far been reported in the literature. We describe a probable further case of LNM in a 67-year-old man with ischemic claudication of the left leg for three years who presented with painful nodules in the left gastrocnemius muscle and signs of systemic disease; a complete follow-up was not possible, because the patient died after only two months and autopsy was not performed. Muscle biopsy showed localized areas of necrotic and inflammatory pleomorphic changes, in keeping with the features of the other known cases. The ultrastructural findings (not previously reported in this disease) were characterized by marked changes of endomysial capillaries, with fibroblastic metamorphosis of the endothelial cells, and by the presence of filamentous inclusions in the myonuclei.
The differential diagnosis of LNM from other localized muscle masses, chiefly from muscle infarct, is discussed.
Sommario
La miosite nodulare localizzata è una rara variante della polimiosite caratterizzata all'esordio da noduli infiammatori circoscritti nell'ambito delle masse muscolari, di cui sono stati sinora descritti solo sette casi. Viene qui riportata un'ulteriore osservazione in un uomo di 67 anni, sofferente di claudicatio ischemica alla gamba sinistra da 3 anni, che aveva presentato noduli dolorosi al muscolo gastrocnemio sinistro e segni di malattia sistemica; il paziente morí dopo 2 mesi, e non fu possibile eseguire autopsia. La biopsia muscolare mostrò aspetti localizzati di necrosi e infiltrazione pleiomorfa, in accordo con le precedenti osservazioni. L'indagine ultrastrutturale (mai descritta finora in quest a malattia) mostrò gravi alterazioni dei capillari endomisiali con metamorfosi fibroblastica delle cellule endoteliali, e presenza di inclusioni filamentose nei mionuclei.
La diagnosi di miosite nodulare localizzata viene discussa nell'ambito delle varie forme di tumefazioni circostritte dei muscoli, con particolare riguardo all'infarto muscolare.
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Marbini, A., Gemignani, F., Parma, M. et al. Localized nodular myositis and the diagnosis of the localized muscle mass. Ital J Neuro Sci 4, 179–184 (1983). https://doi.org/10.1007/BF02043902
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DOI: https://doi.org/10.1007/BF02043902