1
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Uchio N, Komaki S, Sudo T, Matsumoto Y, Hao A, Kojima K, Toda N, Kitamura A, Maeda MH, Kubota A, Matsumoto H. Anti-nuclear matrix protein 2 antibody-positive dermatomyositis with gastrointestinal ulcers: A case report. Int J Rheum Dis 2023; 26:2572-2575. [PMID: 37287416 DOI: 10.1111/1756-185x.14755] [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] [Received: 04/24/2023] [Revised: 05/10/2023] [Accepted: 05/17/2023] [Indexed: 06/09/2023]
Abstract
Gastrointestinal manifestations are a very rare complication of dermatomyositis (DM) and are much less frequent in adult cases than in juvenile cases. Only a few previous papers have reported adult patients who had DM with anti-nuclear matrix protein 2 (anti-NXP2) antibodies and who developed gastrointestinal ulcers. Herein, we report a similar case of a 50-year-old man who had DM with anti-NXP2 antibodies followed by relapsing multiple gastrointestinal ulcers. Even after the administration of prednisolone, his muscle weakness and myalgia deteriorated and gastrointestinal ulcers relapsed. In contrast, intravenous immunoglobulin and azathioprine improved his muscle weakness and gastrointestinal ulcers. Based on the parallel disease activity of the muscular and gastrointestinal symptoms, we considered that his gastrointestinal ulcers were a complication of DM with anti-NXP2 antibodies. We also propose that early intensive immunosuppressive therapy would be required for the muscular and gastrointestinal symptoms in DM with anti-NXP2 antibodies.
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Affiliation(s)
- Naohiro Uchio
- Department of Neurology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Shogo Komaki
- Department of Neurology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Takashi Sudo
- Department of Neurology, Mitsui Memorial Hospital, Tokyo, Japan
| | | | - Akihito Hao
- Department of Neurology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kentaro Kojima
- Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Nobuo Toda
- Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Asuka Kitamura
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Meiko Hashimoto Maeda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akatsuki Kubota
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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2
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Neves A, Mendonça I, Marques J, Costa J, Almeida J. Dermatomyositis and Crohn's disease - Case report. Int J Rheum Dis 2023; 26:2576-2580. [PMID: 37243455 DOI: 10.1111/1756-185x.14757] [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] [Received: 02/12/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
Immune-mediated diseases tend to overlap in ways that are not completely understood. When a presentation is not entirely explained by a former condition, other hypotheses should arise. Additionally, the activity of 2 overlapping immune-mediated conditions is not always associated. We present an unusual association between Crohn's disease and dermatomyositis in a 28-year-old man. The patient presented with a 2-month history of proximal muscle weakness and a skin rash with heliotrope periorbital edema. Since the patient had already been diagnosed with Crohn's disease, he was under immunosuppressive therapy, and he had a family history of psoriasis, the diagnosis was not immediate and required an integrative approach. Laboratory analysis revealed elevated creatine kinase, aldolase, lactic dehydrogenase and transaminase levels. He had no symptoms of Crohn's disease exacerbation. Magnetic resonance imaging, electromyography, and muscle biopsy findings were consistent with inflammatory myopathy, although non-specific. Corticosteroids were initiated with clinical and laboratory improvement within 1 month.
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Affiliation(s)
- Ana Neves
- Internal Medicine Department, Centro Hospitalar Universitário de São João, Oporto, Portugal
| | - Inês Mendonça
- Intensive Care Medicine Department, Centro Hospitalar Universitário de São João, Oporto, Portugal
| | - José Marques
- Internal Medicine Department, Centro Hospitalar Universitário de São João, Oporto, Portugal
| | - José Costa
- Internal Medicine Department, Hospital Terras do Infante, Centro Hospitalar Universitário do Algarve, Lagos, Portugal
| | - Jorge Almeida
- Internal Medicine Department, Centro Hospitalar Universitário de São João, Oporto, Portugal
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3
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Milne M, Sims C, Anderson DR, Johannemann A, Leverenz D, Criscione-Schreiber L, Ardalan K. A Rare Manifestation of a Rare Disease: The Importance of Thinking Outside the Box in a Patient With Complex Dermatomyositis. Arthritis Care Res (Hoboken) 2022; 74:1943-1949. [PMID: 35507472 DOI: 10.1002/acr.24905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/03/2022] [Accepted: 04/28/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Megan Milne
- Duke University School of Medicine, Durham, North Carolina
| | - Catherine Sims
- Duke University School of Medicine, Durham, North Carolina
| | | | | | - David Leverenz
- Duke University School of Medicine, Durham, North Carolina
| | | | - Kaveh Ardalan
- Duke University School of Medicine, Durham, North Carolina
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4
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Gastrointestinal Involvement in Dermatomyositis. Diagnostics (Basel) 2022; 12:diagnostics12051200. [PMID: 35626355 PMCID: PMC9139828 DOI: 10.3390/diagnostics12051200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/27/2022] [Accepted: 05/09/2022] [Indexed: 01/27/2023] Open
Abstract
Dermatomyositis is a systemic vasculopathy mainly affecting skin, muscle and lung, but may affect the gastrointestinal tract. We aim to describe clinical characteristics of patients with severe gastrointestinal involvement related to dermatomyositis in our center and medical literature. We retrospectively analysed these patients in our center, including cases of erosions/ulcers, perforation or digestive bleeding. Reported cases from April 1990 to April 2021 were reviewed through PubMed and Cochrane. From our cohort (n = 188), only 3 presented gastrointestinal compromise. All were women (10, 46 and 68 years). The initial symptom was abdominal pain and all had ≥2 episodes of digestive bleeding. All died due to complications of gastrointestinal involvement. Available pathological samples showed vascular ectasia. From the literature review (n = 50), 77% were women with a mean age of 49 years and the main symptom was abdominal pain (65%). All presented active muscular and cutaneous involvement at complication diagnosis. Mortality was 41.7%. The underlying lesion was perforation or ulcer (n = 22), intestinal wall thickening (n = 2), macroscopic inflammation (n = 2) or intestinal pneumatosis (n = 15). In 13 cases, vasculitis was described. Gastrointestinal involvement in dermatomyositis denotes severity, so an early intensive treatment is recommended. Pathological findings suggest that the underlying pathophysiological mechanism is a vasculopathy and not a true vasculitis.
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5
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Valenzuela A, Rieger KE, Blish CA, Chung L, Fiorentino D. Gastrointestinal Perforation in a Patient With Antinuclear Matrix Protein 2 Antibody-Positive Dermatomyositis. Arthritis Care Res (Hoboken) 2022; 74:1409-1415. [PMID: 35287251 DOI: 10.1002/acr.24879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/23/2022] [Accepted: 03/08/2022] [Indexed: 11/08/2022]
Affiliation(s)
| | - Kerri E Rieger
- Stanford University School of Medicine, Redwood City, California
| | | | - Lorinda Chung
- Stanford University School of Medicine, Redwood City, California
| | - David Fiorentino
- Stanford University School of Medicine, Redwood City, California
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6
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Loftis C, White R, Dulgheru EC. Dermatomyositis- Related Intestinal Dysmotility. Mod Rheumatol Case Rep 2021; 6:189-193. [PMID: 34791372 DOI: 10.1093/mrcr/rxab043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/27/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022]
Abstract
Dermatomyositis (DM) is an inflammatory myopathy characterized by proximal muscle weakness and pathognomonic skin lesions. A 69-year-old woman with a recent diagnosis of DM one month prior, treated with corticosteroids and immunomodulators, presented to our inpatient rehabilitation with worsening dysphagia and constipation. At the time of our evaluation, physical examination was notable for erythematous papules over the MCPs, PIPs, elbows, and knees as well as a violaceous rash on the face. Muscle strength was diminished bilaterally with proximal distribution being affected greater than distal. Laboratory studies were notable for CK level 31 IU/ L, ANA by immunofluorescence of 1:80, and aldolase 4 u/L. The eleven-antibody myositis panel was negative. Skeletal muscle biopsy of the left thigh showed partially treated acquired inflammatory myopathy with perifascicular atrophy. During hospitalization, she was found to have pulmonary embolism. She received enoxaparin 1 mg/kg subcutaneous BID. Soon after, she developed rectal bleeding. Colonoscopy showed a stercoral ulcer caused by chronic constipation. While dysphagia is common, being present in 25-50% of patients with DM, lower gastrointestinal problems involving the small and large intestine are rare and typically present as a late manifestation of the disease. Decreased peristalsis in the large colon can lead to constipation, impaction, and subsequent mucosal ulceration, and pressure necrosis induced by fecaloma formation. Although rare, our case highlights the importance of recognizing gastrointestinal complications that dermatomyositis can cause and the effects that those complications have on morbidity and mortality.
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Affiliation(s)
- Christine Loftis
- Internal Medicine Department- Doctor Hospital at Renaissance, University of Texas at Rio Grande Valley, Edinburg, USA
| | - Rosa White
- Internal Medicine Department- Doctor Hospital at Renaissance, University of Texas at Rio Grande Valley, Edinburg, USA
| | - Emilia C Dulgheru
- University of Texas at Rio Grande Valley, Rheumatology Institute Doctors Hospital at Renaissance, Edinburg, USA
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7
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Luo L, Huang W, Ren F, Zhou J, Huang D, Tang L. Pharyngeal ulceration and perforation: a rare manifestation in anti-MDA5 dermatomyositis. Rheumatology (Oxford) 2021; 60:e132-e133. [PMID: 33197245 DOI: 10.1093/rheumatology/keaa730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/17/2020] [Accepted: 09/30/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lei Luo
- Department of Rheumatology and Immunology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenhan Huang
- Department of Rheumatology and Immunology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feifeng Ren
- Department of Rheumatology and Immunology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Zhou
- Department of Rheumatology and Immunology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dongmei Huang
- Department of Rheumatology and Immunology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Tang
- Department of Rheumatology and Immunology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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8
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Huang BB, Han LC, Liu GF, Lv XD, Gu GL, Li SQ, Chen L, Wang HQ, Zhan LL, Lv XP. Infliximab is effective in the treatment of ulcerative colitis with dermatomyositis: A case report. World J Gastroenterol 2020; 26:7425-7435. [PMID: 33362394 PMCID: PMC7739156 DOI: 10.3748/wjg.v26.i46.7425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/11/2020] [Accepted: 11/04/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Joint, skin, oral cavity, and eye lesions are the most common extraintestinal manifestations of ulcerative colitis that can occur before or after its onset. The cases of ulcerative colitis with dermatomyositis (DM) are rare. In this study, we report a rare case of ulcerative colitis with DM that was effectively treated with infliximab.
CASE SUMMARY The patient was a 57-year-old female with a 2-year history of DM. The patient was admitted to hospital with abdominal pain, diarrhea, and blood in stool lasting for more than 2 mo. Colonoscopy revealed multiple erosions and ulcers in the entire colon and rectum. Pathological sections showed chronic inflammatory cell infiltration, especially neutrophil infiltration, in the colonic mucosa; therefore, the patient was diagnosed with ulcerative colitis. Preparations of 5-aminosalicylic acid was added to her treatment based on the original treatment for DM, but its effect was unsatisfactory. The patient’s discomfort was relieved after infliximab treatment.
CONCLUSION Infliximab can improve DM in the treatment of ulcerative colitis. Specialists need to raise awareness about patients with inflammatory bowel disease who have rare extraintestinal manifestations.
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Affiliation(s)
- Bin-Bin Huang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Li-Chun Han
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Geng-Feng Liu
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Xiao-Dan Lv
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Guang-Li Gu
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Shi-Quan Li
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Lan Chen
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Hui-Qin Wang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Ling-Ling Zhan
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Xiao-Ping Lv
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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9
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Gastrointestinal Tract Vasculopathy: Clinicopathology and Description of a Possible "New Entity" With Protean Features. Am J Surg Pathol 2019; 42:866-876. [PMID: 29624512 DOI: 10.1097/pas.0000000000001060] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Noninfectious gastrointestinal (GI) vasculopathic disorders are rare and are often overlooked in histopathologic examination or when forming differential diagnoses due to their rarity. However, involvement of the GI tract may lead to serious complications, including ischemia and perforation. Since awareness of the types of vasculopathy that may involve the GI tract is central to arriving at a correct diagnosis, we reviewed our institutional experience with GI tract vasculopathy in order to enhance diagnostic accuracy of these rare lesions. We report the clinical and histologic features of 16 cases (excluding 16 cases of immunoglobulin A vasculitis) diagnosed over a 20-year period. Of the 16 patients, 14 presented with symptoms related to the GI vasculopathy (including 2 presenting with a mass on endoscopic examination). The remaining 2 patients presented with incarcerated hernia and invasive adenocarcinoma. The vasculopathy was not associated with systemic disease and appeared limited to the GI tract in 8 patients. Eight had associated systemic disease, but only 6 had a prior diagnosis. The underlying diagnoses in these 6 patients included systemic lupus erythematosus (1), dermatomyositis (2), rheumatoid arthritis (1), eosinophilic granulomatosis with polyangiitis (1), and Crohn disease (1). One patient with granulomatous polyangiitis and 1 patient with systemic lupus erythematosus initially presented with GI symptoms. The 8 cases of isolated GI tract vasculopathy consisted of enterocolic lymphocytic phlebitis (4), idiopathic myointimal hyperplasia of the sigmoid colon (1), idiopathic myointimal hyperplasia of the ileum (1), granulomatous vasculitis (1), and polyarteritis nodosa-like arteritis (1). Isolated GI tract vasculopathy is rare, but appears to be almost as common as that associated with systemic disease. The chief primary vasculopathies are enterocolic lymphocytic colitis and idiopathic myointimal hyperplasia. Although the latter occurs predominantly in the left colon, rare examples occur in the small bowel and likely represent a complex, more protean disorder.
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10
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Okogbaa J, Batiste L. Dermatomyositis: An Acute Flare and Current Treatments. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2019; 12:1179547619855370. [PMID: 31244526 PMCID: PMC6582284 DOI: 10.1177/1179547619855370] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 12/16/2022]
Abstract
The purpose of this case report is to assess and review the literature to determine the frequency of occurrence of dermatomyositis (DM). Dermatomyositis is a rare autoimmune condition that disproportionately affects adolescence and pediatric patients. The symptomatology experienced in this condition includes but not limited to fatigue, reduced mobility, and dysphagia. Symptoms of dysphonia and dyspnea have been reported due to weakened esophageal and respiratory muscle. Another major complication seen in DM is calcinosis. Calcinosis is a calcium deposit on soft tissue. This is mostly been attributed to late diagnosis or use of ineffective treatment regimen. Systemic corticosteroid is the first-line treatment for DM; however, other agents such as anti-malaria, IVIG, and immunosuppressive therapies have been used successfully.
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Affiliation(s)
- John Okogbaa
- Division of Clinical and Administrative Science, Xavier University of Louisiana, New Orleans, LA, USA
| | - Lakeasha Batiste
- Department of Pharmacy, West Jefferson Medical Center, Marrero, LA, USA
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11
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Mulroy E, Cleland J, Child N, Pereira J, Anderson NE. A tough one to swallow. Pract Neurol 2018; 18:250-254. [PMID: 29567648 DOI: 10.1136/practneurol-2017-001860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Eoin Mulroy
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - James Cleland
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Nicholas Child
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Jennifer Pereira
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Neil E Anderson
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
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12
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13
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Bauer EM, Brahn E. Microscopic polyangiitis with dermatomyositis. Eur J Rheumatol 2018; 4:291-293. [PMID: 29308288 DOI: 10.5152/eurjrheum.2017.17008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/16/2017] [Indexed: 11/22/2022] Open
Abstract
Dermatomyositis is a rare autoimmune disease with a heterogeneous presentation that often has multiple extramuscular manifestations, although it does not typically involve the renal function. A 62-year-old female presented with proximal muscle weakness and rashes, which are classic symptoms of dermatomyositis without creatine kinase (CK) elevation. Initial serologic evaluation revealed a positive p-ANCA, although she did not develop renal failure for several months, at which point renal biopsy findings were consistent with microscopic polyangiitis. The patient was initially treated with cyclophosphamide, maintained with rituximab, and has been in remission for more than 2 years. Dermatomyositis and microscopic polyangiitis are both uncommon diseases, but are concomitantly present in this patient. A positive p-ANCA and development of renal insufficiency should be promptly evaluated in dermatomyositis patients.
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Affiliation(s)
- Erin M Bauer
- Department of Rheumatology, University of California, David Geffen School of Medicine, Los Angeles, California, USA.,U.S. Department of Veterans Affairs, Los Angeles, California, USA
| | - Ernest Brahn
- Department of Rheumatology, University of California, David Geffen School of Medicine, Los Angeles, California, USA
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14
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Bucci JC, Trelle MB, McClintock CS, Qureshi T, Jørgensen TJD, Peterson CB. Copper(II) Ions Increase Plasminogen Activator Inhibitor Type 1 Dynamics in Key Structural Regions That Govern Stability. Biochemistry 2016; 55:4386-98. [DOI: 10.1021/acs.biochem.6b00256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Joel C. Bucci
- Department
of Biochemistry and Cellular and Molecular Biology, University of Tennessee, Walters Life Sciences Building, 1414 Cumberland Avenue, Knoxville, Tennessee 37996, United States
- Department
of Biological Sciences, Louisiana State University, A221 Life
Sciences Annex, Baton Rouge, Louisiana 70803, United States
| | - Morten Beck Trelle
- Department
of Biochemistry and Molecular Biology, University of Southern Denmark, 55 Campusvej, 5000 Odense M, Denmark
| | - Carlee S. McClintock
- Department
of Biochemistry and Cellular and Molecular Biology, University of Tennessee, Walters Life Sciences Building, 1414 Cumberland Avenue, Knoxville, Tennessee 37996, United States
| | - Tihami Qureshi
- Department
of Biochemistry and Cellular and Molecular Biology, University of Tennessee, Walters Life Sciences Building, 1414 Cumberland Avenue, Knoxville, Tennessee 37996, United States
| | - Thomas J. D. Jørgensen
- Department
of Biochemistry and Molecular Biology, University of Southern Denmark, 55 Campusvej, 5000 Odense M, Denmark
| | - Cynthia B. Peterson
- Department
of Biochemistry and Cellular and Molecular Biology, University of Tennessee, Walters Life Sciences Building, 1414 Cumberland Avenue, Knoxville, Tennessee 37996, United States
- Department
of Biological Sciences, Louisiana State University, A221 Life
Sciences Annex, Baton Rouge, Louisiana 70803, United States
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15
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Pulham NJ, Cho M, Chan F. A 63-Year-Old Woman With Muscle Weakness and Abdominal Pain. Gastroenterology 2016; 150:e12-3. [PMID: 26930009 DOI: 10.1053/j.gastro.2015.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/27/2015] [Accepted: 11/12/2015] [Indexed: 12/02/2022]
Affiliation(s)
- Nicolas J Pulham
- Section of Digestive Disease, Yale University School of Medicine, New Haven, Connecticut
| | - Margaret Cho
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Francis Chan
- Gastroenterology Center of Connecticut, Yale University School of Medicine, New Haven, Connecticut
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16
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Xiao Y, Zuo X, You Y, Luo H, Duan L, Zhang W, Li Y, Xie Y, Zhou Y, Ning W, Li T, Liu S, Zhu H, Jiang Y, Wu S, Zhao H. Investigation into the cause of mortality in 49 cases of idiopathic inflammatory myopathy: A single center study. Exp Ther Med 2016; 11:885-889. [PMID: 26998007 PMCID: PMC4774336 DOI: 10.3892/etm.2016.3006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 12/17/2015] [Indexed: 12/16/2022] Open
Abstract
Idiopathic inflammatory myopathy (IIM) is an autoimmune disease characterized by chronic muscle weakness and myositis with unknown etiology. IIM may affect the function of multiple organs and has a poor prognosis. In the present study, the causes of mortality in patients with IIM admitted to the Xiangya Hospital during the last 14 years were investigated. The investigation included an analysis of frequent causes of IIM, and of infections and associated complications. A cohort study was conducted on 676 patients with IIM that were admitted to Xiangya Hospital from January, 2001 to January, 2015. There were 49 patient mortalities (7.2% of the total cases), of which 34 mortalities were infection-associated and 15 were not infection-associated. The proportion of infection-associated IIM mortalities had increased since 2001. Of the 34 infection-associated mortalities, 31 cases (63.3%) were of fungal and bacterial infections, most frequently infecting the lungs and the blood. Klebsiella pneumoniae and Acinetobacter baumannii were the most commonly isolated pathogens, and co-infection with the two pathogens was observed in the majority of cases. In the IIM mortalities not associated with infection, there were 2 acute myocardial infarction cases, 2 acute interstitial lung disease cases, 4 malignancies and 1 case of each of the following: Arrhythmia, pneumothorax, ventilator weakness, pulmonary artery hypertension, gastrointestinal bleeding, liver failure and renal failure. Three mortalities were secondary to viral hepatitis in the present study. Pathogenic infection was the most frequent cause of mortality in patients with IIM. The remaining causes of mortality included secondary to heart failure, lung dysfunction and malignancy. Following the ubiquitous application of glucocorticoids and immunosuppressants, the proportion of infection-associated mortalities increased in patients with IIM. Thus, in addition to focusing on the primary disease, infection should receive increased attention during clinical practice.
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Affiliation(s)
- Yizhi Xiao
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Xiaoxia Zuo
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yunhui You
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Hui Luo
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Liping Duan
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Weiru Zhang
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yisha Li
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yanli Xie
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yaou Zhou
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Wangbin Ning
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Tong Li
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Sijia Liu
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Honglin Zhu
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Ying Jiang
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Siyao Wu
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Hongjun Zhao
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
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Kibbi N, Bekui A, Buckley LM. Colonic vasculopathy and perforation in the initial presentation of adult dermatomyositis in a patient with improving muscle weakness. BMJ Case Rep 2016; 2016:bcr-2015-213460. [PMID: 26759443 DOI: 10.1136/bcr-2015-213460] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 63-year-old woman with diabetes presented with 8 weeks of proximal muscle weakness and change in bowel habits. Muscle biopsy confirmed myositis, and serological studies were consistent with dermatomyositis (DM), without evidence of overlapping connective tissue disease or malignancy. On day 12 of prednisone therapy and after receiving one dose of IVIG with improvement in muscle strength, the patient developed abdominal pain and was diagnosed with a gastrointestinal (GI) perforation and peritonitis requiring emergent colectomy. The pathology revealed diffuse mucosal ulceration, prominent lymphoplasmacytic infiltration, venous occlusion and arterial hyperplasia. Although GI manifestations due to GI vasculopathy are rare in adult DM and are often a delayed complication, in this patient, it was one of the initial manifestations of this condition. In addition to being a fatal complication, clinicians should be aware of these complications, as immunosuppression used to control the muscular and cutaneous inflammation may not control the GI vasculopathy.
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Affiliation(s)
- Nour Kibbi
- Department of Internal Medicine, Yale University, New Haven, Connecticut, USA
| | - Amenuve Bekui
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Lenore M Buckley
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Mestre-Torres J, Landolfi S, Selva-O'Callaghan A. Gastrointestinal endarteropathy in adult dermatomyositis. Joint Bone Spine 2015; 83:353-4. [PMID: 26184526 DOI: 10.1016/j.jbspin.2015.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 03/04/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Jaume Mestre-Torres
- Internal Medicine Department, Vall D'hebron General Hospital, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain
| | - Stefania Landolfi
- Pathology Department, Vall D'hebron General Hospital, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain
| | - Albert Selva-O'Callaghan
- Internal Medicine Department, Vall D'hebron General Hospital, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain.
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Marie I, Josse S, Decaux O, Diot E, Landron C, Roblot P, Jouneau S, Hatron PY, Hachulla E, Vittecoq O, Menard JF, Jouen F, Dominique S. Clinical manifestations and outcome of anti-PL7 positive patients with antisynthetase syndrome. Eur J Intern Med 2013; 24:474-9. [PMID: 23375620 DOI: 10.1016/j.ejim.2013.01.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 12/31/2012] [Accepted: 01/03/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND The aims of the present study were to determine both clinical manifestations and outcome of anti-PL7 patients with antisynthetase syndrome (ASS). METHODS The medical records of 15 consecutive anti-PL7 patients with biopsy proven ASS were retrospectively analyzed without prior selection. RESULTS Anti-PL7 patients exhibited polymyositis (n=14) and dermatomyositis (n=1); extra-pulmonary manifestations of ASS included: Raynaud's phenomenon (40%), mechanic's hands (33.3%), joint impairment (26.7%), pericardial effusion (20%) and esophageal/gastrointestinal involvement (20%). The outcome of myositis was as follows: remission/improvement (91.7%) and deterioration (8.3%). Fourteen patients (93.3%) experienced interstitial lung disease (ILD). ILD preceded ASS diagnosis (n=5), was identified concomitantly with ASS (n=8) and occurred after ASS diagnosis (n=1). Patients could be divided into 3 groups according to their presenting lung manifestations: acute onset of lung disease (n=1), progressive onset of lung signs (n=11) and asymptomatic patients exhibiting abnormalities consistent with ILD on PFT and HRCT-scan (n=2). No patient had resolution of ILD, whereas 64.3% and 35.7% experienced improvement and deterioration of ILD, respectively. ILD resulted in respiratory insufficiency requiring O2 therapy in 14.3% of cases. Two patients died. Predictive parameters of ILD deterioration were: DLCO<45% at ILD diagnosis and HRCT-scan pattern of usual interstitial pneumonia (UIP). CONCLUSION Our series mainly underscores that ILD is frequent in anti-PL7 patients, leading to high morbidity. Our study further suggests that patients with predictive factors of ILD deterioration may require more aggressive therapy, especially the group of patients with DLCO<45% at ILD diagnosis and UIP pattern on HRCT-scan.
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Affiliation(s)
- I Marie
- Department of Internal Medicine, CHU Rouen, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France.
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Marie I, Josse S, Decaux O, Dominique S, Diot E, Landron C, Roblot P, Jouneau S, Hatron PY, Tiev KP, Vittecoq O, Noel D, Mouthon L, Menard JF, Jouen F. Comparison of long-term outcome between anti-Jo1- and anti-PL7/PL12 positive patients with antisynthetase syndrome. Autoimmun Rev 2012; 11:739-45. [PMID: 22326685 DOI: 10.1016/j.autrev.2012.01.006] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 01/21/2012] [Indexed: 12/16/2022]
Abstract
The aims of the present study were to: compare the characteristics between antisynthetase syndrome (ASS) patients with anti-Jo1 antibody and those with anti-PL7/PL12 antibody. The medical records of 95 consecutive patients with ASS were reviewed. Seventy-five of these patients had anti-Jo1 antibody; the other patients had anti-PL7 (n=15) or anti-PL12 (n=5) antibody. At ASS diagnosis, the prevalence of myalgia (p=0.007) and muscle weakness (p=0.02) was significantly lower in the group of anti-PL7/PL12-positive patients than in those with anti-Jo1 antibody; median value of CK (p=0.00003) was also lower in anti-PL7/PL12 patients. Anti-Jo1 positive patients developed more rarely myositis resolution (21.3% vs. 46.2%); in addition, the overall recurrence rate of myositis was higher in anti-Jo1 positive patients than in patients with anti-PL7/PL12 antibody (65.9% vs. 19.4%). Anti-Jo1-positive patients, compared with those with anti-PL7/PL12 antibody, more often experienced: joint involvement (63.3%vs. 40%) and cancer (13.3% vs. 5%). By contrast, anti-PL7/PL12 positive patients, compared with those with anti-Jo1 antibody, more commonly exhibited: ILD (90% vs. 68%); in anti-PL7/PL12 positive patients, ILD was more often symptomatic at diagnosis, and led more rarely to resolution of lung manifestations (5.6% vs. 29.4%). Finally, the group of anti-PL7/PL12 positive patients more commonly experienced gastrointestinal manifestations related to ASS (p=0.02). Taken together, although anti-Jo1 positive patients with ASS share some features with those with anti-PL7/PL12 antibody, they exhibit many differences regarding clinical phenotype and long-term outcome. Our study underscores that the presence of anti-Jo1 antibody results in more severe myositis, joint impairment and increased risk of cancer. On the other hand, the presence of anti-PL7/PL12 antibody is markedly associated with: early and severe ILD, and gastrointestinal complications. Thus, our study interestingly indicates that the finding for anti-Jo1 and anti-PL7/PL12 antibodies impacts both the long-term outcome and prognosis of patients with ASS.
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Affiliation(s)
- I Marie
- Department of Internal Medicine, CHU Rouen, and INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France.
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Fang TJ, Hsu SC, Shih MC, Wang CY, Chen LI, Tsai YC, Lin YC. Spontaneous Retroperitoneal Hemorrhage in a Mediastinal Tumor in a Patient With Polymyositis: A Case Report. Kaohsiung J Med Sci 2008; 24:436-40. [PMID: 18926959 DOI: 10.1016/s1607-551x(08)70169-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Tzu-Jung Fang
- Division of General Internal Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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