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Yoshimi R, Nakajima H. Subcutaneous Edema in Polymyositis and Dermatomyositis. Intern Med 2023; 62:2161-2162. [PMID: 37532512 PMCID: PMC10465285 DOI: 10.2169/internalmedicine.1199-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 08/04/2023] Open
Affiliation(s)
- Ryusuke Yoshimi
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
| | - Hideaki Nakajima
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
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2
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Sumida H, Asano Y, Shimizu J, Sato S. Edema localized to the lips as a novel manifestation of myositis. Int J Rheum Dis 2022; 26:789-792. [PMID: 36562716 DOI: 10.1111/1756-185x.14543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/17/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
Polymyositis (PM) and dermatomyositis (DM) are idiopathic inflammatory myopathies with presumed autoimmune pathogenesis, characterized by the features of proximal skeletal muscle weakness and evidence of muscle inflammation. Skin manifestations usually prompt earlier recognition and diagnosis of DM than PM, which has no rash. Associated delayed diagnosis and treatment in PM lead to worse outcomes. Therefore, an accumulation of case reports regarding initial symptoms suggestive of PM has been required to obtain an earlier diagnosis and better clinical outcomes in PM patients. We herein report a PM patient with an unusual presentation of edema restricted to the lips, which was clinically suggestive of granulomatous cheilitis but histologically verified as a manifestation of myositis. In this patient, no myositis-specific antibodies including anti-nuclear matrix protein 2 antibodies, were detected, and histological analysis on the muscle biopsy specimen revealed CD4-dominant lymphocyte infiltration but no C5b-9 deposition nor myxovirus resistance protein A expression. Further analysis with MRI (magnetic resonance imaging) scan of the lips showed increased signal intensity in the muscle layer on short TI inversion recovery images, and these suggest the potential of MRI as a useful tool for exploring the inflammatory site and the possibility of myositis in swollen lips. Thus, our report indicates the importance of suspecting myositis in the case of unusual edema restricted to the lips.
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Affiliation(s)
- Hayakazu Sumida
- Department of Dermatology, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Yoshihide Asano
- Department of Dermatology, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Jun Shimizu
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Shinichi Sato
- Department of Dermatology, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Japan
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Ray AK, Karmakar P, Chandra A, Ghosh SK, Karmakar PS. Generalised oedema as a presenting manifestation of inflammatory myopathy. BMJ Case Rep 2022; 15:e248036. [PMID: 35241448 PMCID: PMC8895946 DOI: 10.1136/bcr-2021-248036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/04/2022] Open
Abstract
Polymyositis is an immune-mediated inflammatory myopathy usually presenting with weakness of proximal muscles in a symmetric pattern. Generalised subcutaneous oedema as presenting feature of inflammatory myopathy, especially polymyositis, has rarely been reported. We report here a case of a young woman who was admitted to our facility with generalised severe subcutaneous oedema. During hospital stay, she gradually developed significant proximal muscle weakness with bulbar symptoms. The initial presentation of the patient masqueraded with other causes of anasarca. However, detailed clinical features, laboratory evaluation, electromyography and muscle biopsy clinched the diagnosis of polymyositis. She was treated with systemic corticosteroids and azathioprine. The patient responded well to treatment and the swelling gradually subsided.
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Affiliation(s)
- Aritra Kumar Ray
- Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Poulami Karmakar
- Department of Internal Medicine, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Atanu Chandra
- Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Sudip Kumar Ghosh
- Dermatology, Venereology, Leprosy, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
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Skourtis A, Geladari E, Margellou E, Jajaj E, Raptis A, Kouvidou C, Vallianou N. Bilateral Subcutaneous Pitting Edema of the Upper Limbs as the Initial Sign of an Indolent Systemic Disease. J Clin Rheumatol 2021; 27:S851-S852. [PMID: 32091454 DOI: 10.1097/rhu.0000000000001345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Eleni Geladari
- Second Internal Medicine Department, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens
| | | | - Edison Jajaj
- From the First Internal Medicine Department, Evangelismos General Hospital
| | - Adamantios Raptis
- From the First Internal Medicine Department, Evangelismos General Hospital
| | | | - Natalia Vallianou
- From the First Internal Medicine Department, Evangelismos General Hospital
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Hepatocellular Carcinoma-Associated Polymyositis Presenting With Unilateral Upper Limb Subcutaneous Edema. Arch Rheumatol 2018; 33:482-487. [PMID: 30874235 DOI: 10.5606/archrheumatol.2018.6688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 01/09/2018] [Indexed: 11/21/2022] Open
Abstract
Localized subcutaneous edema is a rare manifestation of inflammatory myopathy. In general, the incidence of malignancy in dermatomyositis is higher than that in polymyositis (PM). The association between malignancy and dermatomyositis has been established; however, it is less convincing in PM. In this article, we report on a case of malignancy-associated PM with an initial presentation of localized subcutaneous edema. A 66-year-old male patient with a history of chronic hepatitis B was presented to us with both left arm swelling and progressive proximal muscle weakness. A multi-detector row computed tomography showed prominent left arm edema, while a venography demonstrated no venous thrombosis or stenosis. A diagnosis of PM was established according to its typical symptoms, high serum creatine kinase level, positive electromyography findings, and systemic inflammatory signs. Magnetic resonance imaging of the liver revealed infiltrative hepatocellular carcinoma. After undergoing systemic corticosteroid therapy, in combination with hydroxychloroquine, the left arm edema was resolved. However, patient died from hepatocellular carcinoma three months after the date of diagnosis. It is important to recognize that hepatocellular carcinoma-associated PM may initially present itself with localized non-pitting edema. Although such localized edema may be responsive to corticosteroids, a patient's overall prognosis remains poor. We presume that PM with localized subcutaneous edema may be a predictor of malignancy, and therefore recommend a tumor survey.
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Jin UR, Kwack KS, Park KJ, Kwon JE, Kim SY, Kim KC, Ban GY, Jung JY, Suh CH, Kim HA. Acute Polymyositis/systemic Lupus Erythematosus Overlap Syndrome with Severe Subcutaneous Edema and Interstitial Lung Disease. JOURNAL OF RHEUMATIC DISEASES 2014. [DOI: 10.4078/jrd.2014.21.1.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- U-ram Jin
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Kyu-Sung Kwack
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Kyung-Joo Park
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Ji-Eun Kwon
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Si-Yeon Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Ki-Chan Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Ga-Yong Ban
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Ju-Yang Jung
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Chang-Hee Suh
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
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Haroon M, Eltahir A, Harney S. Generalized Subcutaneous Edema as a Rare Manifestation of Dermatomyositis. J Clin Rheumatol 2011; 17:135-7. [DOI: 10.1097/rhu.0b013e318214f1a9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Acute dermatomyositis associated with generalized subcutaneous edema. Rheumatol Int 2008; 28:797-800. [PMID: 18193426 DOI: 10.1007/s00296-008-0520-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2007] [Accepted: 12/16/2007] [Indexed: 10/22/2022]
Abstract
Generalized subcutaneous edema is an uncommon manifestation of inflammatory myopathy. We report a 48-year-old female patient who presented with severe generalized edema, an erythematous skin rash, dysphagia and proximal muscle weakness. She was diagnosed with dermatomyositis from the clinical signs, increased muscle enzymes, electromyographic findings and a muscle biopsy. Magnetic resonance imaging revealed increased signal intensity in the muscular and subcutaneous layers. The conditions causing generalized edema were excluded. It was concluded that the generalized edema was secondary to dermatomyositis. Aggressive treatments with high-dose glucocorticoids and immunosuppressive agents were used to control the severe subcutaneous edema.
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Ito Y, Kawabata D, Yukawa N, Yoshifuji H, Usui T, Tanaka M, Fujii T, Mimori T. Severe subcutaneous generalized edema in a patient with dermatomyositis. Mod Rheumatol 2007; 17:171-3. [PMID: 17437177 DOI: 10.1007/s10165-006-0560-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Accepted: 12/26/2006] [Indexed: 11/25/2022]
Abstract
Subcutaneous generalized edema associated with dermatomyositis (DM)/polymyositis (PM) is extremely rare. Herein we report a case of severe subcutaneous generalized edema complicating DM. A 78-year-old woman was hospitalized in our department because of massive edema in the four limbs. Elevated muscle enzymes, heliotrope rash, results of electromyography, and muscle biopsy confirmed the diagnosis of DM. The absence of other diseases that could cause the symptoms indicated that massive edema was correlated with the pathophysiology of DM. Although myopathy and edema responded well to oral prednisolone, dysphagia persisted. We conclude that subcutaneous generalized edema can occur during the course of DM/PM, and subcutaneous vasculopathy may be involved in the pathogenesis of DM/PM.
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Affiliation(s)
- Yoshinaga Ito
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
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Werner de Castro GR, Appenzeller S, Bértolo MB, Costallat LTL. Acute dermatomyositis with subcutaneous generalized edema. Clin Rheumatol 2006; 25:898-900. [PMID: 16308667 DOI: 10.1007/s10067-005-0053-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2005] [Accepted: 05/06/2005] [Indexed: 10/25/2022]
Abstract
The authors report a 40-year-old Caucasian man with relapsing muscle and skin involvement of dermatomyositis treated with high-dose corticosteroids, taken orally, and methotrexate and human gamma globulin, both administered intravenously. After 4 months of aggressive treatment, he presented with generalized edema, considered secondary to dermatomyositis. Aggressive immunosuppression did not stop disease progression. The literature concerning anasarca due to inflammatory myopathies is revised.
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Affiliation(s)
- Gláucio R Werner de Castro
- Rheumatology Unit, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Distrito de Barão Geraldo, 13081-970, Campinas-SP, Brazil
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Karabiber H, Aslan M, Alkan A, Yakinci C. A rare complication of generalized edema in juvenile dermatomyositis: a report of one case. Brain Dev 2004; 26:269-72. [PMID: 15130694 DOI: 10.1016/s0387-7604(03)00171-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2003] [Revised: 08/10/2003] [Accepted: 08/28/2003] [Indexed: 12/01/2022]
Abstract
Juvenile dermatomyositis (JDM) is a rare autoimmune disease characterized by inflammation of the muscle, connective tissue, skin, gastrointestinal tract and small nerves. Periorbital and facial edema may also be associated. Although localized edema is a common feature of juvenile dermatomyositis, generalized edema has been reported rarely. In this article, we report a 14-year-old boy with juvenile dermatomyositis presenting with generalized edema. Of the diagnostic criteria of JDM, severe symmetric weakness of the proximal musculature, characteristic cutaneous changes, elevated serum muscle enzymes and myopathic electromyographic abnormalities were observed. Magnetic resonance imaging (MRI) of the lower extremities and pelvis showed marked diffuse edema in the subcutaneous tissue, muscles and myofascia. We suggest that MRI findings, which are not among the diagnostic criteria, may also be included in the diagnostic criteria of JDM. To the best of our knowledge, this is the 19th case of JDM reported for generalized edema in the English literature.
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Affiliation(s)
- Hamza Karabiber
- Department of Pediatrics, Kahramanmaras Sutcuimam Universitesi Medical School, Tip Fakultesi Pediatri Anabilim Dali, 46050 Kahramanmaras, Turkey.
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Mitchell JP, Dennis GJ, Rider LG. Juvenile dermatomyositis presenting with anasarca: A possible indicator of severe disease activity. J Pediatr 2001; 138:942-5. [PMID: 11391348 DOI: 10.1067/mpd.2001.113363] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Juvenile dermatomyositis is a rare autoimmune disease characterized by inflammation of the muscle, skin, and other organs. Although localized edema is a common feature of juvenile dermatomyositis, generalized edema has been reported infrequently. We describe a patient with juvenile dermatomyositis presenting with anasarca and note that generalized edema has been associated with severe disease activity.
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Affiliation(s)
- J P Mitchell
- Department of Rheumatology and Clinical Immunology, Walter Reed Army Medical Center, 6900 Georgia Ave. NW, Ward 77, Washington, DC 20307, USA
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