MEDizzy - A 17-year-old boy has had generalized muscle pain with fever

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Infectious Diseases

A 17-year-old boy has had generalized muscle pain with fever for 1 week. Over the past 2 days, he has developed increasing muscular weakness and diarrhea. On physical examination, his temperature is 38° C. All of his muscles are tender to palpation, but he has a normal range of motion, and no significant decrease in muscle strength. Laboratory findings include hemoglobin, 14.6 g/dL; hematocrit, 44.3%; MCV, 90μm3; platelet count, 275,000/mm3; and WBC count, 16,700/mm3 with differential of 68% segmented neutrophils, 6% bands, 10% lymphocytes, 4% monocytes, and 12% eosinophils. What is the most likely diagnosis?

ExplanationAcute muscle pain with fever and eosinophilia suggests a parasitic infestation of the skeletal muscles, most likely trichinosis; this results from ingesting poorly cooked meat infected with Trichinella spiralis larvae. Hemorrhagic fever can be a mild disease with myalgia, but can be severe with extensive vascular endothelial damage. Influenza A and B infection may produce myositis in childhood, with more severe, focal, and later onset than the diffuse myalgias of typical flu. Poliomyelitis can lead to muscle weakness, but via neurogenic atrophy, through loss of motor neurons.