Posters
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Resident
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Internal Medicine
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Internal Medicine
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Internal Medicine
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Patient Care
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Case Report
Abstract
Background: Myositis is muscle inflammation commonly causing symmetrical pain, especially in the proximal muscles, often triggered by viral infections. Epstein-Barr Virus (EBV), a human-exclusive virus, is linked to acute viral myositis (AVM). Typically, AVM presents with sudden bilateral muscle pain and systemic symptoms like fever, nausea, and vomiting, occurring after a recent respiratory or gastrointestinal infection. Diagnosis involves measuring creatine kinase (CK) levels, liver function tests, and viral studies. While viral myositis is self-limiting and generally resolves within two weeks with supportive care, complications like rhabdomyolysis can occur. We present a case of EBV-induced viral myositis with significantly elevated CK levels but without rhabdomyolysis.
Case Presentation: A 20-year-old Hispanic male with no significant medical history, except for occasional cannabis use, presented to the ED with a 1.5-month history of severe occipital headaches, vomiting, and anxiety. Over the past two days, he developed generalized weakness, subjective fever, muscular neck pain, left upper quadrant pain, and mild muscle cramps. He denied hematuria and used ibuprofen for headache relief. On examination, vital signs were stable, but the patient had mild abdominal tenderness and dry mucosa. Lab results showed leukocytosis, elevated creatinine, hypokalemia, and significantly elevated liver enzymes. Creatine kinase (CK) was markedly elevated (21,766 U/L), and a respiratory viral panel was positive for rhinovirus. Imaging revealed hepatic steatosis and mild maxillary sinus disease. The patient was admitted due to SIRS, elevated CK levels on viral myositis with concerns of rhabdomyolysis, possible acute kidney injury (AKI), and started on IV fluids and broad-spectrum antibiotics. His lab values improved significantly during hospitalization, and EBV testing confirmed the diagnosis of EBV-induced viral myositis, complicated with AKI. At discharge, he was asymptomatic and tolerating a normal diet.
Conclusions: Acute viral myositis (AVM) can result from various infections, including Epstein-Barr virus (EBV), parainfluenza, and herpes simplex virus, though influenza A is more commonly reported. Diagnosing AVM is challenging due to non-specific symptoms and the lack of definitive serological confirmation for viral etiologies. A key complication of AVM is rhabdomyolysis, which can lead to serious outcomes like acute kidney injury (AKI), but not all cases present with the classical triad of muscle weakness, brown urine, and pain.
This case highlights EBV as a cause of viral myositis complicated by AKI, but without rhabdomyolysis. We hypothesize the AKI resulted from tubular injury linked to the viral infection and dehydration. While few cases in the literature link EBV to AVM with AKI or rhabdomyolysis, our case adds to this body of evidence. Notably, the patient’s positive rhinovirus test raises the question of potential interaction, though viral myositis due to rhinovirus is rare, especially in adults.
Clinicians should be aware that elevated creatine kinase (CK) levels do not always indicate rhabdomyolysis and should maintain a high index of suspicion for AVM complications, ensuring early identification and supportive therapy.
Recommended Citation
Loayza Pintado, Jose J.; Aboytes Trevino, Jorge; and Suarez Parraga, Andres, "When Creatine Kinase Soars: A Case of Viral Myositis in the Absence of Rhabdomyolysis" (2025). Research Symposium. 80.
https://scholarworks.utrgv.edu/somrs/2025/posters/80
Included in
When Creatine Kinase Soars: A Case of Viral Myositis in the Absence of Rhabdomyolysis
Background: Myositis is muscle inflammation commonly causing symmetrical pain, especially in the proximal muscles, often triggered by viral infections. Epstein-Barr Virus (EBV), a human-exclusive virus, is linked to acute viral myositis (AVM). Typically, AVM presents with sudden bilateral muscle pain and systemic symptoms like fever, nausea, and vomiting, occurring after a recent respiratory or gastrointestinal infection. Diagnosis involves measuring creatine kinase (CK) levels, liver function tests, and viral studies. While viral myositis is self-limiting and generally resolves within two weeks with supportive care, complications like rhabdomyolysis can occur. We present a case of EBV-induced viral myositis with significantly elevated CK levels but without rhabdomyolysis.
Case Presentation: A 20-year-old Hispanic male with no significant medical history, except for occasional cannabis use, presented to the ED with a 1.5-month history of severe occipital headaches, vomiting, and anxiety. Over the past two days, he developed generalized weakness, subjective fever, muscular neck pain, left upper quadrant pain, and mild muscle cramps. He denied hematuria and used ibuprofen for headache relief. On examination, vital signs were stable, but the patient had mild abdominal tenderness and dry mucosa. Lab results showed leukocytosis, elevated creatinine, hypokalemia, and significantly elevated liver enzymes. Creatine kinase (CK) was markedly elevated (21,766 U/L), and a respiratory viral panel was positive for rhinovirus. Imaging revealed hepatic steatosis and mild maxillary sinus disease. The patient was admitted due to SIRS, elevated CK levels on viral myositis with concerns of rhabdomyolysis, possible acute kidney injury (AKI), and started on IV fluids and broad-spectrum antibiotics. His lab values improved significantly during hospitalization, and EBV testing confirmed the diagnosis of EBV-induced viral myositis, complicated with AKI. At discharge, he was asymptomatic and tolerating a normal diet.
Conclusions: Acute viral myositis (AVM) can result from various infections, including Epstein-Barr virus (EBV), parainfluenza, and herpes simplex virus, though influenza A is more commonly reported. Diagnosing AVM is challenging due to non-specific symptoms and the lack of definitive serological confirmation for viral etiologies. A key complication of AVM is rhabdomyolysis, which can lead to serious outcomes like acute kidney injury (AKI), but not all cases present with the classical triad of muscle weakness, brown urine, and pain.
This case highlights EBV as a cause of viral myositis complicated by AKI, but without rhabdomyolysis. We hypothesize the AKI resulted from tubular injury linked to the viral infection and dehydration. While few cases in the literature link EBV to AVM with AKI or rhabdomyolysis, our case adds to this body of evidence. Notably, the patient’s positive rhinovirus test raises the question of potential interaction, though viral myositis due to rhinovirus is rare, especially in adults.
Clinicians should be aware that elevated creatine kinase (CK) levels do not always indicate rhabdomyolysis and should maintain a high index of suspicion for AVM complications, ensuring early identification and supportive therapy.
