Unusual case of bilateral hand weakness

Area of Science:

• Neurology
• Infectious Diseases
• Musculoskeletal Disorders

Background:

• Viral infections can manifest with diverse neurological complications.
• Influenza A (H1N1) is known to cause various post-infectious syndromes.
• Myositis, or muscle inflammation, is a recognized but less common complication.

Observation:

• A 35-year-old man developed severe myalgia and bilateral hand weakness post-H1N1 influenza.
• Functional impairment was noted, with mildly elevated creatine kinase and myopathic electromyogram findings.
• Respiratory muscle weakness (reduced forced vital capacity) was transient.

Findings:

• The patient was diagnosed with viral myositis affecting distal forearm muscles.
• Nerve conduction studies ruled out neuropathy.
• Supportive intravenous fluid therapy resulted in rapid improvement of muscle weakness.

Implications:

• Distal forearm myositis is a rare but important differential diagnosis for post-infectious neurological symptoms in adults.
• Early recognition and supportive care can lead to favorable outcomes.
• This case underscores the varied neurological presentations of influenza.