{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:02:24Z","timestamp":1764547344568,"version":"3.46.0"},"reference-count":21,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:p>Streptococcus pyogenes (GAS) is responsible for many pediatric infections. Although outcomes are generally favorable with prompt diagnosis and treatment, it is necessary for pediatricians to remain vigilant for complications. We discuss a rare GAS complication: post-streptococcal myositis. An 8-year-old female patient recently hospitalized for cervical lymphadenitis presented with extremity pain and difficulty walking. Initial work-up revealed marked nonspecific inflammation, normal creatine kinase (CK), and superficial thrombophlebitis. Her symptoms progressed rapidly to high fevers, erythematous nodules, severe pain and edema, and superficial thrombophlebitis extension despite antibiotics and nonsteroidal anti-inflammatory pharmacotherapy. This was associated with rising inflammatory markers, extensive myositis of the extremities and mild fasciitis of the calves on imaging, and a muscle biopsy with normal architecture and no evidence of vasculitis or necrosis. A markedly elevated anti-streptolysin O (ASO) and anti-DNase B led to the diagnosis of post-streptococcal myositis. Symptoms responded rapidly to systemic steroids, with complete recovery within 5\u00a0months. Limited case reports of post-streptococcal myositis exist, which similarly describe severe myalgia and fevers, inflammation, elevated ASO, and typically normal CK. Most describe a self-limited disease course. This case describes a unique manifestation and sequelae of streptococcal infection in a child with an impressive degree of systemic inflammation and thrombotic complications. This report also describes pediatric muscle biopsy results in association with this diagnosis. Post-streptococcal myositis should be considered for patients with severe unexplained inflammation and myalgia.<\/jats:p>","DOI":"10.1542\/peds.2025-070952","type":"journal-article","created":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:02:50Z","timestamp":1763424170000},"source":"Crossref","is-referenced-by-count":0,"title":["Post-Streptococcal Myositis: Etiology of Myalgia and Severe Inflammation in a Child"],"prefix":"10.1542","volume":"156","author":[{"given":"Lindy J.","family":"Pence","sequence":"first","affiliation":[{"name":"1Cincinnati Children\u2019s Hospital, Cincinnati, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minal A.","family":"Aundhia","sequence":"additional","affiliation":[{"name":"1Cincinnati Children\u2019s Hospital, Cincinnati, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamal","family":"Alanni","sequence":"additional","affiliation":[{"name":"1Cincinnati Children\u2019s Hospital, Cincinnati, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne K.","family":"Jackson","sequence":"additional","affiliation":[{"name":"1Cincinnati Children\u2019s Hospital, Cincinnati, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel J.","family":"Lovell","sequence":"additional","affiliation":[{"name":"1Cincinnati Children\u2019s Hospital, Cincinnati, Ohio"},{"name":"2Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine C.","family":"Soe","sequence":"additional","affiliation":[{"name":"1Cincinnati Children\u2019s Hospital, Cincinnati, Ohio"},{"name":"2Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio"},{"name":"3Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2025,11,18]]},"reference":[{"issue":"1","key":"2025113018572889000_r1","doi-asserted-by":"crossref","first-page":"e47","DOI":"10.1093\/cid\/ciaa529","article-title":"Incidence of pharyngitis, sinusitis, acute otitis media, and outpatient antibiotic prescribing preventable by vaccination against group A Streptococcus in the United States","volume":"73","author":"Lewnard","year":"2021","journal-title":"Clin Infect Dis."},{"issue":"10","key":"2025113018572889000_r2","first-page":"1949","article-title":"Evaluation of poststreptococcal illness","volume":"71","author":"Hahn","year":"2005","journal-title":"Am Fam Physician."},{"issue":"8","key":"2025113018572889000_r3","first-page":"517","article-title":"Poststreptococcal illness: recognition and management","volume":"97","author":"Maness","year":"2018","journal-title":"Am Fam Physician."},{"issue":"11","key":"2025113018572889000_r4","doi-asserted-by":"crossref","first-page":"4641","DOI":"10.1007\/s00431-024-05786-y","article-title":"Benign acute childhood myositis: a scoping review of clinical presentation and viral etiology","volume":"183","author":"Majava","year":"2024","journal-title":"Eur J Pediatr."},{"issue":"1","key":"2025113018572889000_r5","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1136\/ard.45.1.47","article-title":"Acute poststreptococcal polymyalgia","volume":"45","author":"Harats","year":"1986","journal-title":"Ann Rheum Dis."},{"issue":"6","key":"2025113018572889000_r6","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1542\/peds.80.6.953","article-title":"Acute poststreptococcal polymyalgia with trismus","volume":"80","author":"Gremse","year":"1987","journal-title":"Pediatrics."},{"issue":"2","key":"2025113018572889000_r7","first-page":"165","article-title":"Polimialgia aguda postestreptoc\u00f3cica: a prop\u00f3sito de dos casos. [Post-streptococcal acute polymyalgia: apropos of two cases]","volume":"31","author":"Alonso Ortiz","year":"1989","journal-title":"An Esp Pediatr."},{"issue":"6","key":"2025113018572889000_r8","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1007\/BF02029359","article-title":"Acute post-streptococcal polymyalgia: two new cases with a review of the literature","volume":"154","author":"Venuta","year":"1995","journal-title":"Eur J Pediatr."},{"issue":"12","key":"2025113018572889000_r9","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1093\/rheumatology\/37.12.1343","article-title":"Post-streptococcal reactive myalgia: a novel syndrome secondary to infection with group A or G streptococci","volume":"37","author":"Jansen","year":"1998","journal-title":"Br J Rheumatol."},{"issue":"7","key":"2025113018572889000_r10","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1093\/rheumatology\/41.7.827","article-title":"A rare case of recurrent post-streptococcal myalgia","volume":"41","author":"Subramanian","year":"2002","journal-title":"Rheumatology (Oxford)."},{"issue":"3","key":"2025113018572889000_r11","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1007\/s12098-011-0507-9","article-title":"Post streptococcal myalgia: an under-recognized clinical syndrome","volume":"79","author":"Arun Babu","year":"2012","journal-title":"Indian J Pediatr."},{"issue":"9","key":"2025113018572889000_r12","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1542\/pir.35.9.396","article-title":"Index of suspicion","volume":"35","author":"Ostrom","year":"2014","journal-title":"Pediatr Rev."},{"issue":"12","key":"2025113018572889000_r13","doi-asserted-by":"crossref","first-page":"901","DOI":"10.7326\/L18-0589","article-title":"Poststreptococcal myalgia and myositis","volume":"170","author":"Bomers","year":"2019","journal-title":"Ann Intern Med."},{"issue":"5","key":"2025113018572889000_r14","first-page":"42","article-title":"Post streptococcal myalgia: a subdiagnosed disorder \u2013 a case report","volume":"5","author":"Ferreras","year":"2021","journal-title":"Int J Med Rev Case Reports."},{"key":"2025113018572889000_r15","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.jpeds.2022.02.057","article-title":"Poststreptococcal myalgia and protracted febrile myalgia syndrome: similar yet different","volume":"247","author":"Shlomovitz","year":"2022","journal-title":"J Pediatr."},{"issue":"1","key":"2025113018572889000_r16","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1186\/s12891-024-07941-w","article-title":"Post-streptococcal myositis - ultrasound features of an under-recognised disorder: a case report","volume":"25","author":"Grie\u00dfmann","year":"2024","journal-title":"BMC Musculoskelet Disord."},{"issue":"3","key":"2025113018572889000_r17","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1001\/archopht.1981.03930010439009","article-title":"Orbital myositis after upper respiratory tract infection","volume":"99","author":"Purcell","year":"1981","journal-title":"Arch Ophthalmol."},{"issue":"4","key":"2025113018572889000_r18","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/S1529-1839(05)70300-6","article-title":"Orbital myositis following streptococcal pharyngitis in a pediatric patient","volume":"76","author":"Culligan","year":"2005","journal-title":"Optometry."},{"issue":"4","key":"2025113018572889000_r19","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1111\/j.1440-1754.2008.01288.x","article-title":"Orbital myositis following streptococcal pharyngitis","volume":"44","author":"Alshaikh","year":"2008","journal-title":"J Paediatr Child Health."},{"issue":"2","key":"2025113018572889000_r20","first-page":"81","article-title":"La myosite orbitaire post-streptococcique: \u00e0 propos d\u2019un cas [Post-streptococcal myositis orbital in a pediatric patient: A case report]","volume":"24","author":"Hmami","year":"2011","journal-title":"J Pediatr Pueric."},{"issue":"1","key":"2025113018572889000_r21","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1080\/09273948.2017.1367408","article-title":"Orbital inflammatory syndrome post group A Streptococcal infection - case series and review of literature","volume":"27","author":"Rabina","year":"2019","journal-title":"Ocul Immunol Inflamm."}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2025-070952\/1889920\/pediatrics.2025070952.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2025-070952\/1889920\/pediatrics.2025070952.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T23:57:34Z","timestamp":1764547054000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/156\/6\/e2025070952\/205462\/Post-Streptococcal-Myositis-Etiology-of-Myalgia"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,18]]},"references-count":21,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,11,18]]},"published-print":{"date-parts":[[2025,12,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2025-070952","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"type":"print","value":"0031-4005"},{"type":"electronic","value":"1098-4275"}],"subject":[],"published":{"date-parts":[[2025,11,18]]},"article-number":"e2025070952"}}