[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 T2-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.
