title: Focal myositis of lower extremity responsive to botulinum A toxin.
abstract: Focal myositis is a rare, mostly benign disease (pseudotumor) of skeletal muscle, histopathologically characterized by interstitial myositis and tumorous enlargement of a single muscle. The etiology of focal myositis remains unknown; however, localized myopathy has been postulated to be caused by denervation lesions. This case report describes a patient that presented with clinical, laboratory, electromyoneurography, and magnetic resonance imaging features of focal myositis complicated with intervertebral disk protrusion in the lumbosacral spine affected with radicular distress. In most cases, focal myositic lesions show spontaneous regression, relapses are rare, and long-term prognosis is good. There is a wide spectrum of therapeutic options, from no therapy at all through nonsteroidal antirheumatics and glucocorticoids to radiotherapy, surgical excision, and immunosuppressants. In the patient presented, treatment with glucocorticoids, methotrexate, and surgical excision failed to produce satisfactory results. Clinical improvement, pain relief, and reduction in lower leg volume were only achieved by local infiltration of botulinum A toxin.
authors.affiliation: *Divisions of Clinical Immunology and Rheumatology and †Hematology, Department of Internal Medicine, ‡Department of Plastic, Reconstructive and Aesthetic Surgery, and §Division of Clinical Pharmacology, Department of Internal Medicine, University Hospital Dubrava, Zagreb, Croatia.
authors.forename: Josko
authors.initials: J
authors.lastname: Mitrovic
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Prka
authors.forename: Rado
authors.initials: R
authors.lastname: Zic
authors.forename: Srecko
authors.initials: S
authors.lastname: Marusic
authors.forename: Jadranka
authors.initials: J
authors.lastname: Morovic-Vergles
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007273:Injections, Intramuscular; D035002:Lower Extremity / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009220:Myositis / Q000188:drug therapy* / Q000473:pathology
chemical_list: D019274:Botulinum Toxins, Type A