Annals of the Rheumatic Diseases, 1986; 45, 47-49 Acute poststreptococcal polymyalgia

SUMMARY Three patients developed severe incapacitating diffuse pain and tenderness of the skeletal muscles after acute streptococcal infection. There was no evidence of concomitant arthritis, glomerulonephritis, or inflammatory muscle disease in any of the cases. All patients responded promptly to anti-inflammatory therapy. Severe myalgia should be considered an additional complication of immunologically mediated poststreptococcal response. Rheumatic fever, acute poststreptoccal glomeru-lonephritis, Schonlein-Henoch purpura, and ery-thema nodosum are well recognised, immunologi-cally mediated complications of streptococcal disease.1 On the other hand, severe diffuse pain and tenderness of skeletal muscles without concom-itant arthritis is not a recognised feature of post-streptococcal disease. Recently, we encountered three patients who developed incapacitating acute myalgia after streptococcal infection. Case histories CASE 1 A 13-year-old girl was admitted to our department because of severe myalgia involving the upper and lower limbs of three days ' duration. Two weeks before admission she had had an upper respiratory infection. She also had fever, arthralgia of the small joints of the hands, and was bedridden because of pain. She had not received any medication. On admission her temperature was 39°C and she had a diffuse giant urticarial rash. The throat, lungs, and abdomen showed no abnormal findings. The heart sounds were normal, and no murmurs were heard. There was severe bilateral tenderness and weakness of the deltoid, biceps, and quadriceps muscles, but there were no signs of arthritis. Laboratory tests showed an erythrocyte sedi-mentation rate (ESR) of 80 mm after one hour (Westergen), haemoglobin 11-1 g/dl (111 g/l) with normocytic normochromic indexes, leucocytes 8100/ mm3 (8-1 x 109/l), and thrombocytes 515 000/mm