Recurrent focal myositis with extraocular and lower limb muscle involvement: a case report
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Abstract
Background: Focal myositis is a rare, localized inflammatory myopathy of unknown etiology. Owing to its rarity and nonspecific presentation, it is frequently misdiagnosed, which may result in delayed or inappropriate management.
Case Presentation: We report the case of a 37-year-old woman who presented with a three-day history of pain, swelling, and tenderness involving both calf muscles, accompanied by right-sided periorbital edema and diplopia. She had no systemic symptoms or clinical features suggestive of an underlying autoimmune disorder. Laboratory investigations revealed elevated creatine kinase and inflammatory markers. Magnetic resonance imaging (MRI) of the lower limbs demonstrated extensive edema of the right gastrocnemius muscle with associated subcutaneous edema, along with mild edema of the left gastrocnemius and soleus muscles. MRI of the brain and orbits showed inflammatory changes in the right lateral rectus muscle with surrounding periorbital edema. This was her third hospital presentation over the past decade with similar clinical manifestations. An extensive diagnostic workup excluded infectious, autoimmune, metabolic, and malignant causes. A diagnosis of idiopathic recurrent focal myositis with multifocal involvement was established. While her previous two episodes resolved spontaneously without immunosuppressive therapy, the current episode required immunosuppressive treatment due to persistent symptoms and to reduce the risk of recurrence.
Conclusion: This case illustrates the recurrent and multifocal presentation of focal myositis and emphasizes the need to consider this rare entity in patients presenting with localized muscle inflammation. Early recognition is crucial to prevent unnecessary investigations and to facilitate timely and appropriate treatment, particularly in recurrent or persistent cases.
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