Severe epidemic myalgia with an elevated level of serum interleukin-6 caused by human parechovirus type 3: a case report and brief review of the literature

Kiwamu Nakamura,Tetsuji Aoyagi,Hiromu Takemura,Keiji Kanemitsu,Fumihito Ikeda,Kadzuhiro Kitakawa,Kyoichi Saito,Yasuka Hara,Yoshinobu Abe,Mitsuo Kaku

doi:10.1186/s12879-018-3284-5

Abstract

BackgroundHuman parechovirus type 3 (HPeV-3) is known to cause cold-like symptoms, diarrhea, or severe infections such as sepsis in infants and children. In adults, HPeV-3 infection is rarely diagnosed because the symptoms are generally mild and self-limiting; however, this infection has been linked to epidemic myalgia, regardless of the presence of underlying diseases, immunosuppression, or sex.Case presentationWe describe an adult case of severe systemic myalgia and orchiodynia after infection with HPeV-3, which was transmitted from the child of the patient. Interleukin-6 (IL-6) level was found to be elevated in the patient’s serum.ConclusionSevere myalgia associated with HPeV-3 infection is potentially caused by an elevated serum level of IL-6.

Highlights

Human parechovirus type 3 (HPeV-3) is known to cause cold-like symptoms, diarrhea, or severe infections such as sepsis in infants and children
While the overall seropositivity rate for HPeV-3 was 79.4% in residents of Yamagata prefecture, the necessary antibody titer for preventing HPeV-3 infection decreases in adults as they age [13]. This might suggest that adults who do not have sufficient titers of NT antibodies may develop HPeV-3 infection after occasional contact with infected children, and a few individuals may have further complication, such as with epidemic myalgia
Elevated creatine phosphokinase (CK) and myoglobin levels occurred in 55% and 73% of patients, respectively, indicating that CK and myoglobin are not always elevated in patients with epidemic myalgia, regardless of severity

Summary

Introduction

Human parechovirus type 3 (HPeV-3) is known to cause cold-like symptoms, diarrhea, or severe infections such as sepsis in infants and children. All reported adult cases of epidemic myalgia due to HPeV-3 have occurred only in Japan, despite the ubiquity of HPeV-3 in Europe, Asia, We describe an adult case of severe systemic myalgia and orchiodynia after infection with HPeV-3, which was transmitted from the child of the patient.

Results

Conclusion