Myositis? Lyme? What?

[nafstan]

Symptoms:  Woozy in head initially 3 weeks ago. Hard to concentrate and focus during woozinessThen persistent biceps and sometimes forearm weakness, quadriceps and hamstring tightness and weakness and heavy fatique daily last almost 3 weeks now.  Sometimes woozy during, sometimes not.  The muscle weakness moves around.  Some days mostly arms, some days mostly legs, some days both.  All blood labs normal except Creatine Kinase is 280, flagged as high/elevated.  

About 2 months ago I had two small itchy "bite marks" on my left arm behind my watch.  Itched a little.  Small rash around it.  No tick noticed.  I was in my office when I noticed.   But made me suspicious once these symptoms started.  No fever, no chills, no joint pain, no nausea.  Just arm and leg weakness and fatigue daily,

I'm on day 10 of Doxycycline and have been taking Aleve for about 5 days for the muscle weakness which as helped some.  My Dr. wants me to take Prednisone for possibly unspecified myositis while I await more tests.   I don't want to suppress my immune system with Prednisone if I might have Lyme.  Lyme test was negative but I hear the test is wholly unreliable.  

Completely confused.    any ideas?

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

The laboratory results are quite unremarkable. If you continue to be symptomatic you should have additional testing evaluating for possible thyroid dysfunction, B12 abnormality, rheumatology abnormalities (such as Sjogrens, Lupus, etc), infectious (such as lyme), etc. You may also benefit from an EMG/NCS to determine the extent, if any, damage to your nerves. Lastly, many times, post-viruses and other infections can leave a patient fatigued with generalized muscle aches.

Continue following up with your primary care physician for additional workup.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[nafstan]

Thank you.  I only provided a portion of the labs.   My thyroid reading was normal.  My Lyme and Erhlichiosis were negative (though I hear they are often worthless tests, who knows), and the ANA test above I thought included Lupus and it currently shows negative.   Yet, I remain symptomatic into 5th week.  I'm not a doctor, but I find it interesting that inflammatory myopathy of some sort is one indication by elevated CK, (I was 280 and currently being retested), but all the other 'inflammatory tests' above (e.g. Sed Rate, C=Reactive Protein, etc...) are not indicative of inflammation.   I just wonder if CK is high enough to try to talk the neurologist into a muscle biopsy.

Neurology appt on Monday and Inf. Disease following Monday.  The fatigue is oppressive.  Thx.

[nafstan]

Update -- latest labs, didn't show CK unfortunately, getting that done again Weds.  Here are the results I'm hoping someone familiar with myositis might weigh in on.  These seem encouraging against the various forms of myositis.  But, its just one battery.  There is still the original elevated CK and no other sign of infections from my blood labs.  (Could still be Lyme I guess).

Anti-Jo-1 01 Jul 2011 12:00 AM
- Anti-Jo-1: <0.2 Reference Range: 0.0-0.9
ANA with reflex 01 Jul 2011 12:00 AM
- ANA Direct: Negative Reference Range: Negative
LDH 01 Jul 2011 12:00 AM
- LDH: 156 iu/l Reference Range: 0-225
Sedimentation Rate-Westergren 01 Jul 2011 12:00 AM
- Sedimentation Rate-Westergren: 1 mm/hr Reference Range: 0-23
C-Reactive Protein, Quant 01 Jul 2011 12:00 AM
- C-Reactive Protein, Quant: 0.1 mg/L Reference Range: 0.0-4.9
Aldolase 01 Jul 2011 12:00 AM
- Aldolase: 5.4 u/l Reference Range: 1.2-7.6.