A 49-year-old man developed recurrent myalgia and hyperCKemia during acute attacks of neuromyelitis optica. Muscle biopsy was performed, and the pathological findings were analyzed. Predominant myofibrillar pathology was observed, which constitutes a unique finding that has not been reported before. This case result shows that neuromyelitis optica-associated hyperCKemia can produce variable pathologic phenotypes. Further studies are needed to elucidate the relationship between myofibril destruction and aquaporin 4 autoimmunity.

Parvovirus B19 (PVB19) infection is a rare cause of meningoencephalitis. A 53-year-old previously healthy woman presented with fever, headache, and multiple erythema on the both legs. Cerebrospinal fluid study revealed pleocytosis and elevated opening pressure and protein level. Brain MRI showed multiple, asymmetric, hyperintensity in the brain stem, basal ganglia, white matter, and gray matter. Anti-B19 IgM antibody and PCR for PVB19 were positive in serum. Clinician should consider PVB19 infection in any case of acute febrile illness with erythema and meningoencephalitis

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• Clinical manifestations and treatment outcomes of parvovirus B19 encephalitis in immunocompetent adults
  Jin-Sun Jun, Jangsup Moon, Jung-Ick Byun, Jun-Sang Sunwoo, Jung-Ah Lim, Soon-Tae Lee, Keun-Hwa Jung, Kyung-Il Park, Ki-Young Jung, Manho Kim, Sang Kun Lee, Kon Chu
  Journal of NeuroVirology.2017; 23(6): 903.     CrossRef