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Heavy legs after vaccine

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BACM—benign acute childhood myositis. Providers should inquire about any family history of neuromuscular disease, recent vigorous exercise or trauma, drug or medication use, similar episodes with myalgias or pigmentation, and any relevant past medical history, particularly metabolic, musculoskeletal, or thyroid disease.

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Abrupt onset of reluctance to walk with severe lower leg pain occurs at a median of 3 days as the initial viral illness resolves. Patients might be afebrile or have a mildly elevated temperature but otherwise should have normal vital signs.

The distinguishing feature with BACM is the findings of bilaterally symmetric lower extremity examination. Investigations Laboratory testing should be limited to children who will not walk at all.

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Imaging studies should only be used to exclude alternative diagnoses. Indications to perform imaging include concern about trauma, osteomyelitis, malignancy, or deep vein thrombosis. Magnetic resonance imaging might serve as a noninvasive confirmatory tool but is not currently recommended.

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Tippett and Clark recommended that workup include routine complete blood count, C-reactive protein levels, creatine kinase levels, liver function tests, and urine myoglobin measurement—all in an effort to rule out other, more ominous, disease processes. In a large Canadian prospective study, over 2 influenza seasons, 5 of 26 children between the ages of 5 and 15 were admitted. Only 1 patient had a prolonged illness with intermittent leg pain and gait abnormalities for 7 weeks, while all others fully recovered after 2 to 3 weeks.

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In one review, 10 of patients developed rhabdomyolysis, 8 of whom had renal failure. If there is any muscle weakness or abnormal neurologic findings, any signs of inflammation, a lack of improvement after 3 days, or asymmetrical lower extremity pain, BACM is unlikely and an alternative diagnosis should be sought. Myoglobinuria is rare and when it occasionally occurs these patients should be admitted to hospital for monitoring.

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Parents and providers should be reassured that prognosis for BACM is excellent and patients can be effectively managed with simple analgesia at home. Clinical follow-up can be arranged with full clinical and laboratory recovery expected at 2 weeks.

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The mission of the PRETx program is to promote child health through evidence-based research in therapeutics in pediatric emergency medicine. Do you have questions about the effects of drugs, chemicals, radiation, or infections in children?

To earn credits, go to www. La traduction en français de cet article se trouve à www. Competing interests None declared References 1. Tippett E, Clark R. Benign acute childhood myositis following human parainfluenza virus type-1 infection.

Emerg Med Australas.

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Epub Apr 8. Jain S, Kolber MR. A stiff-legged gait: benign acute childhood myositis.

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Epub Oct Leichtenstern Heavy legs after vaccine. In: Mannaberg J, editor. Malaria, influenza and dengue.

Viral myositis in children

Philadelphia, PA: W. Lundberg A. Myalgia cruris epidemica. Acta Paediatr. Influenza-associated myositis in children. Benign acute childhood heavy legs after vaccine laboratory and clinical features. Severe myositis during recovery from influenza.

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Unnecessary varicoza sines noga investigations in benign acute childhood myositis: a case series report. Scott Med J. Neurological and muscular manifestations associated with influenza B infection in children.

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Pediatr Neurol. Benign acute myositis associated with H1N1 influenza A virus infection. Eur J Pediatr.

Viral myositis in children

Epub Mar 7. Benign acute childhood myositis in an accident and emergency setting. Emerg Med J. Magnetic resonance imaging of biceps femoris muscles in benign acute childhood myositis. Arch Neurol. Fatal rhabdomyolysis following influenza infection in a girl with familial carnitine palmityl transferase deficiency.