Question of the Week

Question

Question :

Posted On : 07 May 2020

Boy is 7 yr 9 months old and last week he had a fever since 2-3 days, vomiting since 2-3 days which was treated with some antibiotics and antipyretic, after 2-3 days he suddenly complained of a lot of pain in legs, eyes and he was not able to stand and walk due to pain.
He was hospitalized and during his biochemistry investigation it was found that his blook CPK- total levels were 4815 whereas normal range is 40-160.
On the same day of hospitalization after giving IV NS and combiflam he was able to walk with a reduction in pain. he was hospitalized for 3 days, in that he had fever twice and leg pain reduces, he was walking without pain. His pediatric even checked Gower`s sign on him which was negative.
His CBC report was fine except that platelet count on day 1 of admission was 1,55,000 and after 2 days it was 1,28,000. It was not repeated later.
Now at discharge, we were asked to repeat his CPK after 8 days and there he was diagnosed as acute myositis.
Mother has a history of consanguine marriage to 1 degree. This son of hers has also had febrile convulsions earlier twice with an interval of 3 years and he was totally fine post that. He was put on Sodium Valproate for around 2 years.
1} can CPK rise to this level in the viral origin of fever?
2} do we need to undergo any more investigations to rule out genetic involvement?
3} can genetic cause be suspected in this?
4} what precautions does he need to take now?

Expert Answer :

Answer Discussion :

No answer discussion available.

Answer 1

1} CPK level in this range is seen with acute myositis. I feel that your nephew had a viral myositis given his thrombocytopenia. Check a repeat CPK when he is fully asymptomatic {2-3 weeks}.
2} I do not feel genetic workup is indicated as febrile seizures and viral myositis are both provoked and unrelated to each other.
3} If CPK normalizes, no need for any further workup.
4} Keep him well hydrated, watch out for color change in urine or reduced urine output. Good protein diet. Viral myositis should not recur.

Question of the Week

Home

Partner Sites