Epstein-Barr Virus Induced Myositis in a Patient with Mitochondrial Diabetes

Epstein-Barr virus (EBV) is a rare but well-known trigger for acute myositis. Diagnosis is primarily based on the clinical presentation and an accounting laboratory profile. Patients with mitochondrial dysfunction are potentially at a higher risk of myopathic exacerbations upon exposure to acute insults. This is due to the high energy requirements of myofibers and their reliance on sufficient mitochondrial performance. Hence, any mitochondrial insult can compromise the function of myofibers. This has implications on the management of people with pre-existing mitochondrial dysfunction, with scope for preventative measures and a lower threshold for diagnosis of myopathies. Usually, management is limited to conservative measures. Medications which predispose to muscle injury need to be withheld during the acute episode and their long-term need reviewed based on a risk-benefit analysis. Here, we present a case of acute EBV-induced myositis on a background of maternally inherited diabetes and deafness and chronic statin intake.

Myositis can be an infrequent complication of Epstein-Barr virus infection.The presence of mitochondrial dysfunction could potentially increase the risk of myositis. In patients with mitochondrial diabetes a prolonged course of acute myositis symptoms can be expected.Statins should be discontinued during an acute myositis episode in patients with mitochondrial diabetes but can potentially be re-initiated (with preference to hydrophilic ones) after episode resolution at the lowest possible dose.