LETTER TO THE EDITOR Anasarca as the initial presentation of juvenile polymyositis: an uncommon occurrence Dhrubajyoti Sharma • Surjit Singh • Deepti Suri • Amit Rawat • Upender Shava • Kushaljit S. Sodhi Received: 10 March 2011 / Accepted: 10 July 2011 / Published online: 31 July 2011 Ó Springer-Verlag 2011 Abstract Polymyositis is uncommon in childhood. Unlike dermatomyositis, which is common in pediatric age group, skin involvement is lacking in polymyositis. We report an 8-year-old boy who presented with anasarca as the initial complaint. This presentation has been rarely reported before in the pediatric literature. Keywords Anasarca Á Juvenile Á Polymyositis Sir, Polymyositis is a rare childhood inflammatory muscle disease affecting the proximal muscles. It is rare below the age of 18 years [1]. Unlike dermatomyositis, which is common in pediatric age group, skin involvement is lack- ing in polymyositis [2, 3]. We report an 8-year-old boy who presented with anasarca as the initial complaint. Subsequent evaluation led to a diagnosis of polymyositis. To the best of our knowledge, such presentation of poly- myositis has never been described in pediatric literature. G, an 8-year-old boy, presented with intermittent fever for 1 month. Progressively increasing swelling of the body was noticed since 15 days. Swelling first appeared around the neck and then progressed to involve both upper and lower limbs and then spread on to the whole body. Soon the parents noticed that the child was unable to get up from supine position. There was a history of nasal twang of voice since 15 days. He had pain and tenderness in the calf muscles. There was no history of rash. On examination, weight was 20 kg (5th percentile) and height 117 (5th percentile). He was febrile (101°F) with heart rate 144 per minute, respiratory rate 28 per minute and blood pressure 120/78 mm Hg. Neurological examination showed normal mental functions and cranial nerves. Muscles were tender. Muscle power was grade 3 in bilateral hip flexors and adductors, grade 4 in hip abductors, bilateral shoulder, elbow, knee and neck flexors, and also in bilateral exten- sors, adductors and abductors of shoulder joint. Deep ten- don reflexes were elicitable. There was absent gag reflex. Investigations revealed hemoglobin of 1.37 mmol/L, total leukocyte count 13.4 9 10 9 /L; differential count showed polymorphs 0.82, lymphocytes 0.13, monocytes 0.02 and eosinophils 0.03. Erythrocyte sedimentation rate was 56 mm in 1st hour (Westergren). Urea, creatinine, billirubin and electrolytes were normal. Transaminases were elevated (SGOT 310 U/L, SGPT 118 U/L), serum alkaline phosphatase 120 U/L, total serum protein 65 g/L, serum albumin 27 g/L. Muscle enzymes were elevated [creatine phosphokinase 4,065 U/L (normal: 26–308 U/L) and lactate dehydrogenase 1,200 U/L (normal: 240–480 U/L)]. C-reactive protein was positive, and antistreptolysin O titre was negative. There was no albuminuria. Urine and blood cultures were sterile. Antinuclear antibody and Hepatitis B surface antigen were negative. Serologies done for Human Immunodeficiency Virus, Filaria, Trichinella, Toxoplasma, Parvovirus and Epstein—Barr virus were negative. Magnetic resonance imaging (MRI) revealed bulky involved muscles and patchy T2 hyperintense signal in muscles of bilateral thigh with patchy enhancement after intravenous contrast (Fig. 1a, b). D. Sharma Á S. Singh (&) Á D. Suri Á A. Rawat Á U. Shava Allergy Immunology Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India e-mail: surjitsinghpgi@rediffmail.com K. S. Sodhi Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India 123 Rheumatol Int (2012) 32:2589–2590 DOI 10.1007/s00296-011-2054-0