Abstract
The 33-year-old-man was admitted because of purpura and pain above the both legs. One month ago, he suffered from lacunar tonsillitis and was treated with antibiotics.
On admission, he appeared actually ill, with petechiae and purpuric spots over the extremities and the face. He complained of severe pain in the both thighs, though neither muscle weakness nor atrophy was prominent. The serum creatinine phophokinase value was 41 units (normal: 0 to 35 U) and 24-hour excreations of creatine in urine was 572 mg. Test for C-reactive protein was positive; antistreptolysis 0 titer (ASLO) was 480 Todd units; antistreptokinase titer (ASK) was 81,920 U; Electromyogram revealed a pattern of low amplitude neuromuscular units.
Clinical signs and symptoms suggested his disease as vascular purpura with polymyositis syndrome. Microscopical findings of the muscle showed to be uneven muscle fibers and wide-opened endomysim. They were compatible with polymyositis of vasculo-interstitial type.
Five months later, he suffered from glomerulonephritis.
Considering that the common pathognomonic factor between the vascular purpura and polymyositis is an angitis, it could be presumed that the infection with hemolytic streptococcus caused the angitis as well as glomerulonephritis.
