10 year girl Complains of b/l pain of thigh 4 months back, which started after retuning from school. Progressive pain limited to thigh muscle only and also tenderness. Other muscles are normal power and no tender. Jerk of both knee is brisk and others normal. No sensory loss. Bowel and bladder control preserve. Fully consious, on seizure. Now bed ridden with persistent cough without expectoaton and not controlled by cough suppressant.
Thachypenic, precordial pain. B/l chest clear, normal heart sounds, no organomrgally, no lymphadenopathy; normal blood parmeter. Cpk,ldh,thyrio function,ccp,rft,lft, electrolytes with calcium, muscle biopsy, NCT, MRI of thigh comes out to be normal. ESR of 15m/hr and X Ray of thigh, hip and lumber is normal. EMG shows myopathy like activity. Pt is on calcium,mutivitamins,vit_E, recieved steroid, but no improvement. What should be the next line of…
