Objectives: Differentiating genetic myopathies from inflammatory myopathies can be challenging because of multiple overlapping clinical features. Examples are presented to highlight important clinical features that assist in the differentiation between the two. Methods: Clinical features including age at onset, history, pattern of weakness, serum creatine kinase activity, electromyography findings, and muscle biopsies are reported in six patients initially thought to have an inflammatory myopathy in whom the final diagnosis was a genetic myopathy. Results: All six patients met Bohan and Peter criteria for at least probable idiopathic polymyositis and were subsequently found to have a genetic myopathy (4 DYSF, RYR1, and GNE). The key distinguishing clinical were minimal to no response to immunosuppression and atypical involvement of distal muscles in the majority of cases. Conclusions: Patients diagnosed with inflammatory myopathies should be reevaluated for the possibility of a genetic myopathy if they fail to respond to a course of disease-modifying agents and/or there is atypical distal muscle involvement.

We previously reported an association between human parechovirus type 3 (HPeV3) and epidemic myalgia with myositis in adults during summers in which an HPeV3 outbreak occurred in children. However, this disease association has not yet been reported elsewhere. We have since continued our surveillance to accumulate data on this disease association and to confirm whether myalgia occurs in children as well as adults. Between June and August 2014, we collected 380 specimens from children with infectious diseases. We also collected clinical specimens from two adult and three paediatric patients suspected of myalgia. We then performed virus isolation and reverse-transcription–PCR using the collected specimens. We detected HPeV3 in 26 children with infectious diseases, which we regarded as indicating an outbreak. We also confirmed HPeV3 infection in all patients suspected of myalgia. In particular the symptoms in two boys, complaining of myalgia and fever, closely matched the criteria for adult myalgia. Based on our findings from 2008, 2011 and 2014, we again urge that clinical consideration be given to the relationship between myalgia and HPeV3 infections during HPeV3 outbreaks in children. Furthermore, our observations from 2014 suggest that epidemic myalgia and myositis occur not only in adults but also in children.

Infectivity of Trichinella pseudospiralis in Chinese hamsters was greater than that of Trichinella spiralis. Concurrent infection with these two species of parasite was accompanied by an increase in infectivity of T. spiralis. The infectivity of T. pseudospiralis, but not that of T. spiralis, was significantly influenced by host age. Regardless of host age, T. pseudospiralis was more infective for the Chinese hamster than was T. spiralis. Early during infection, enteritis (myeloperoxidase activity) in hamsters infected with T. pseudospiralis alone was significantly less than that seen in animals infected with T. spiralis alone or with both species concurrently. Myositis in hamsters infected with T. pseudospiralis alone was significantly less on days 14, 17 and 25 post-infection (p.i.) than that observed in concurrently infected or T. spiralis-infected animals. On days 11 and 14 p.i. inflammation in diaphragm muscle from concurrently infected hamsters was significantly less than that seen in animals infected with T. spiralis alone. Muscle histology supported these chemical data on myositis. Suppression of the host inflammatory response against early muscle-stage larvae of T. pseudospiralis underlies the greater infectivity of this parasite for the Chinese hamster.

Focal myositis (of Heffner) in the right trapezius and paraspinal muscles accompanied by a pseudotumour of the left orbit has not been reported previously. The clinical, pathological and radiological features of these unusual benign pseudotumours of the head and neck are discussed. Computerized tomography (CT) scan of the neck and orbital ultrasound were suggestive of an inflammatory process without an abscess formation. This was followed by fine needle aspiration cytology (FNAC), which confirmed the diagnosis. The patient was treated with intravenous steroids and antibiotics, that led to complete resolution of symptoms, and there was no recurrence at six months follow-up. This report highlights the importance of imaging in inflammatory neck swellings.

We describe a rare case of proliferative myositis affecting the lateral border of the tongue. The site of the lesion and its gross pathological presentation were highly suggestive of a malignant process. Subsequent biopsy and characteristic histological appearance led to the diagnosis of this benign condition. This is the first reported case of a painful presentation of proliferative myositis involving the tongue. This report serves to remind the head and neck surgeon of the need to obtain histological diagnosis of malignancy before embarking upon radical surgical treatment. We recommend careful follow-up to ensure complete resolution of the lesion.

Sera of some patients afflicted with the inflammatory disease myositis contain antibodies of the anti-PL-12 type. A fraction of these polyclonal autoantibodies specifically precipitates the fully matured human tRNAAla bearing the anticodon IGC (PL-12 antigen). Earlier work (Bunn & Mathews, 1987, Science 238:116–119) had shown that the epitopes are located entirely within the anticodon stem-loop of the tRNAAla. Here we demonstrate that human anti-tRNAAla autoantibodies immunoprecipitate a synthetic polyribonucleotide containing inosine (I) and N1-methylinosine (m1I) separated by 2 nt as in the anticodon stem-loop of human tRNAAla. The shortest polyribonucleotide that can be immunoprecipitated corresponds to the pentanucleotide IpGpCpm1IpUp, which corresponds to part of the anticodon loop of human tRNAAla and lacks the stem-loop structure. The efficiency of immunoprecipitation was about four times greater with longer polyribonucleotides capable of forming a stem-loop structure, and was abolished by altering the relative positions of I and m1I within the synthetic polynucleotide. Synthetic oligodeoxyribonucleotide analogs of the tRNAAla stem-loop, containing the sequence dIpdGdCdm1Ip, are not antigenic. Our results show that human anti-tRNAAla autoantibodies selectively recognize chemical details of modified nucleotides (the 6-keto group of inosine-34 and the 6-keto group and the N1-methyl groups of N1-methylinosine-37) within an anticodon loop structure of a tRNA molecule. We also describe the chemical synthesis of the phosphoramidite derivatives corresponding to N1-methylinosine and N1-methyl-2′-deoxyinosine for use in the automatic chemical synthesis of oligonucleotides containing N1-methylinosine and N1-methyl-2′-deoxyinosine.