Acute myositis as an unusual presentation of Wegener's granulomatosis.

Wegener's granulomatosis (WG) is a necrotizing granulomatous vasculitis of small arteries and veins typically involving the respiratory tract and kidneys. 1 The disease is uncommon in adults and is rarely diagnosed in the pediatric population. The clinical presentation typically involves the lungs, kidneys, nasopharynx, and paranasal sinuses. 2 Patients often present with recurrent otitis and sinusitis, pulmonary infiltrates, arthralgias, and myalgias. 1 The diagnosis in children may be delayed because of its relative rarity or failure to recognize its varied clinical manifestations. 3-7 We recently evaluated and treated a patient with WG who presented with severe myalgias, elevated creatinine phosphokinase (CPK) levels, and histologic evidence of acute myonecrosis. Patient Report. Severe lower-extremity myalgias and low back pain developed in a 14-year-old girl that impaired her ambulation. Three weeks previously, the patient was treated for serous otitis media, otalgia, and streptococcal pharyngitis. Myalgias began soon after the pharyngitis had subsided. Subsequently,