[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 .

Diseases
Validation

Diseases presenting "first episode" symptom

22q11.2 deletion syndrome

acute rheumatic fever

benign recurrent intrahepatic cholestasis

focal myositis

pyruvate dehydrogenase deficiency

systemic capillary leak syndrome

trochlear dysplasia

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