EC Paediatrics

Background: Benign acute childhood myositis BACM is a self limited sudden onset of lower extremity pain and refusing to walk which considered a highly concerning sign to the parents. The primary complaint of pain in the calves in child presenting with a history of recent viral illness should bring BACM to the fore front of clinicians minds. Abrupt onset of severe lower leg pain occurs at a median of 3 days as the initial viral illness resolves.

Objective: In our study we want to explore that the treatment of BACM with IVIG (Intravenous immunoglobulin) will leads to decrease the estimated length of hospital stay to less than 2 day with a rapid recovery of walking difficulty without complications and with a high parental satisfaction among children presented with inability to walk in HBTGH.

Methods: We conducted a retrospective study on all the children admitted at Hotat Beni Tamim General Hospital at Saudi Arabia with the diagnosis of BACM and treated with IVIG (0.5 G/KG). In the last 5 years (from January 2019 to March 2024), the medical records of children diagnosed with BACM admitted were reviewed retrospectively. The following variables were retrieved from their electronic files: age, sex, prodromal symptoms, presenting symptoms, initial CPK level, follow up CPK level, total leukocytic count, length of stay, management with IVIG.

Results: Increased CPK level in (100%) ranging from 605 to 6410 U/L the median value of CPK at the peak was 1149 UI/L with a follow up decrease with median number 159 UI/L (normal CPK level < 150 UI/L). The p-value was 0.0001297 indicate that there is a significant difference between the CK-level and follow-up CK-level. Estimated length of stay was 1.9 days, in comparison with most literature 4 - 5 days. In our study all patients were treated with IVIG 0.5 G/KG one dose 10 cases (59%) and 2 doses 7 cases (41%).

Conclusion: Our study over 5 years and from 17 cases diagnosed as BACM demonstrated that our demographic results is like other studies but what is exciting in our study that our management of these cases with one or two doses of IVIG associated with a dramatic improvement in the child symptoms and without complications which has a great impact on the child and family satisfaction. And also by decreasing estimated length of stay to less than two days that reflects on a decrease in hospital acquired infection, and the overall patient cost.

 Keywords: Benign Acute Childhood Myositis BACM; Viral Illness; Prodromal Symptoms

1. Giacomo Brisca., et al. “Management and outcome of benign acute childhood myositis in pediatric emergency department”. Italian Journal of Pediatrics 47 (2021): 57.
2. Lundberg A. “Myalgia cruris epidemica”. Acta Paediatrica 1 (1957): 18-31.
3. Rennie LM., et al. “Benign acute childhood myositis in an accident and emergency setting”. Emergency Medicine Journal10 (2005): 686-688.
4. Koliou M., et al. “A case of benign acute childhood myositis associated with influenza A (H1N1) virus infection”. Clinical Microbiology and Infection 2 (2010): 193-195.
5. Federica Attaianese., et al. “Benign acute children myositis: 5 years experience in a tertiary care pediatric hospital”. European Journal of Pediatrics 10 (2023): 4341-4349.
6. Hyczko AV., et al. “A crawling case of benign acute childhood myositis”. SAGE Open Medical Case Reports 9 (2021): 10.
7. A Costa Azevedo., et al. “Benign acute childhood myositis: A 5-year retrospective study”. Archives de Pédiatrie 7 (2022): 490-493.
8. Sabine Mall., et al. “A large outbreak of influenza B-associated benign acute childhood myositis in Germany, 2007/2008”. The Pediatric Infectious Disease Journal 8 (2011): e142-e146.
9. Mannix R., et al. “Acute pediatric rhabdomyolysis: causes and rates of renal failure”. Pediatrics5 (2006): 2119-2125.
10. Korinthenberg R., et al. “Diagnosis and treatment of Guillain-Barré syndrome in childhood and adolescence: an evidence- and consensus-based guideline”. European Journal of Paediatric Neurology 25 (2020): 5-16.