A rare fallacy of dysphagia and myoglobinuria with preserved renal function in viral myositis

Dysphagia is a rare presentation in patients with viral myositis. As per Literature, only 10%–20% of patients with myositis developed weakness of oropharyngeal, laryngeal, and oesophageal musculature that leads to impairment in swallowing.1-5 Acute renal failure associated with myoglobinuria is the most serious complication of myositis causing rhabdomyolysis, which can be life threatening.6 Here we are describing case of a 25-year-old gentleman who presented with fever, myalgia and myoglobinuria, who was diagnosed as viral myositis with dysphagia and Preserved renal functions. A 25-year-old male presented with complaints of generalised diffuse muscle pain associated with stiffness of 2 weeks duration. Blood investigations showed elevated blood counts, transaminitis, elevated Creatine phosphokinase (CPK) levels. CPK levels crossed 1 lakh (102,700 IU/L) on day 6 and his urine gradually became dark brown colour over the successive days. Myositis profile was sent, which turned out to be negative. Urine myoglobin was positive, but his renal functions were preserved throughout course of hospital stay. In view of clinical suspicion of myositis and rising CPK levels, he was started on IV pulse steroids. MRI and Muscle biopsy was suggestive of viral myositis. In view clinical deterioration, he was started on IVIG infusion. His CPK levels reduced gradually and he began to improve clinically. He was noted to have severe dysphagia and nasality of voice with delayed hyolaryngeal elevation. Oral and palatal strengthening exercises, including Masako manoeuvre were initiated. In view of dysphagia, he was started on Ryles tube feeding. He was gradually started on oral blended semi solids and was advised to continue palatal strengthening exercises. He became clinically better and was discharged. He is under our regular follow up and is showing good progress. Dysphagia is a rare presentation in viral myositis and is much more common in steroid-resistant patients. This is an atypical presentation of viral myositis with severe involvement of muscles of deglutition and myoglobinuria with preserved renal parameters. As a conclusion, rarely Viral myositis can present with involvement of muscles of deglutition and myoglobinuria with preserved renal functions. Treatments we gave here were IV steroids and IVIG. Thus, our case demonstrates that Viral myositis with dysphagia can be completely reversed with aggressive medical and rehabilitative therapy.