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[A case of unilateral recurrent calf myalgia with muscle edema due to venous congestion].
[focal myositis]
We
report
a
38
-
year
-old
man
who
had
three
episodes
of
pain
and
swelling
in
the
right
calf
from
the
age
of
27
years
.
On
each
episode
,
pain
worsened
gradually
,
lasted
for
a
few
months
and
subsided
spontaneously
.
Venography
performed
at
the
first
episode
was
reported
to
be
unremarkable
.
At
the
third
episode
,
physical
examinations
showed
tender
and
hard
muscles
in
the
right
calf
without
findings
of
knee
arthritis
.
The
right
calf
pain
became
stronger
when
standing
than
when
lying
and
on
the
ankle
dorsiflexion
.
Laboratory
examinations
showed
leukocytosis
,
a
slightly
elevated
level
of
CRP
,
and
normal
CK
levels
.
MRI
showed
diffuse
high
intensities
in
the
right
soleus
and
the
lateral
head
of
right
gastrocnemius
on
T
2
-
weighted
images
,
where
CT
showed
slightly
low
densities
.
To
rule
out
focal
myositis
,
the
right
soleus
was
biopsied
.
The
muscle
specimen
showed
perimysial
and
endomysial
edema
,
dilatation
of
venules
and
capillaries
,
and
focal
mononuclear
cell
infiltration
in
the
venule
wall
.
Intermyofibrillar
networks
were
well
preserved
.
There
were
no
necrotic
or
regenerating
fibers
,
nor
sarcolemmal
expression
of
HLA-
ABC
.
On
electron
microscopy
,
the
processes
of
fibroblasts
in
the
endomysium
were
swollen
.
This
case
illustrated
muscle
edema
caused
by
local
venous
congestion
possibly
due
to
venulitis
of
unknown
cause
.
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Diseases presenting
"slightly low densities"
symptom
focal myositis
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