1
|
Xiong J, Balakrishnan T, Fong W. Anasarca as the first presentation of anti-synthetase syndrome. BMJ Case Rep 2024; 17:e258359. [PMID: 38749521 DOI: 10.1136/bcr-2023-258359] [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] [Indexed: 09/06/2024] Open
Abstract
A woman in her 70s presented with anasarca and exertional dyspnoea. Investigation showed severe hypoalbuminaemia with no urinary or gastrointestinal protein losses. CT thorax reported lung consolidations, and transbronchial lung biopsy demonstrated organising pneumonia. Autoimmune myositis serology was positive for anti-Jo-1, anti-Ro-52, and anti-PM/Scl-100 antibodies. She was diagnosed with anti-synthetase syndrome with organising pneumonia. She was treated with oral prednisolone and oral mycophenolate mofetil with a good clinical response.
Collapse
Affiliation(s)
- Jiaqing Xiong
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | | | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Office of Education, Duke-NUS Graduate Medical School, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
2
|
Cheng I, Wong CSM. A systematic review and meta-analysis on the prevalence and clinical characteristics of dysphagia in patients with dermatomyositis. Neurogastroenterol Motil 2023; 35:e14572. [PMID: 37010885 DOI: 10.1111/nmo.14572] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/31/2023] [Accepted: 03/14/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Dermatomyositis (DM) is a rare autoimmune disease characterized by distinctive skin rash, muscle inflammation with symmetrical and progressive muscle weakness, and elevated serum levels of muscle-associated enzymes. DM may affect skeletal muscles involved in swallowing, leading to dysphagia, which can negatively impact individual's physical and psychosocial well-being. Despite this, dysphagia in patients with DM remains poorly understood. This systematic review and meta-analysis aimed to evaluate the prevalence and clinical features of dysphagia in patients with DM and juvenile DM (JDM). METHODS Four electronic databases were systematically searched until September 2022. Studies with patients with DM or JDM and dysphagia were included. The pooled prevalence of all included studies was calculated, and the clinical characteristics of dysphagia were qualitatively analyzed. KEY RESULTS Thirty-nine studies with 3335 patients were included. The overall pooled prevalence of dysphagia was 32.3% (95% CI: 0.270, 0.373) in patients with DM and 37.7% (95% CI: -0.031, 0.785) in patients with JDM. Subgroup analyses revealed that Sweden had the highest prevalence (66.7% [95% CI: 0.289, 1.044]), whereas Tunisia had the lowest prevalence (14.3% [95% CI: -0.040, 0.326]). Moreover, South America had the highest prevalence (47.0% [95% CI: 0.401, 0.538]), whereas Africa had the lowest prevalence (14.3% [95% CI: -0.040, 0.326]). Dysphagia in patients with DM and JDM was characterized by both oropharyngeal and esophageal dysfunctions, with predominant difficulties in motility. CONCLUSIONS & INFERENCES Our findings showed that dysphagia affects one in three patients with DM or JDM. However, the documentation on the diagnosis and management of dysphagia in the literature is inadequate. Our results highlighted the need to use both clinical and instrumental assessments to evaluate swallowing function in this population.
Collapse
Affiliation(s)
- Ivy Cheng
- Department of Medicine, School of Clinical Medicine, Lee Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Christina Sze-Man Wong
- Department of Medicine, School of Clinical Medicine, Lee Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Division of Dermatology, Department of Medicine, Queen Mary Hospital, Hong Kong, China
| |
Collapse
|
3
|
Nishioka H, Shindo T, Shimizu H. Dermatomyositis Presenting with Generalized Subcutaneous Edema. Intern Med 2023; 62:2273-2277. [PMID: 37532515 PMCID: PMC10465278 DOI: 10.2169/internalmedicine.0687-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/03/2022] [Indexed: 08/04/2023] Open
Abstract
Generalized subcutaneous edema is rare in dermatomyositis. We herein report an 82-year-old woman with dermatomyositis who presented with generalized subcutaneous edema. Three weeks before admission, she first noticed facial edema, and the symptoms exacerbated, with limb edema occurring. On admission, muscle weakness in the limbs and skin rash were noted. Her muscle enzyme levels were elevated, and serum anti-transcriptional intermediary factor 1-γ antibody was detected. She was diagnosed with dermatomyositis and treated with corticosteroids and tacrolimus, which improved her muscle weakness, muscle enzymes, and edema. Thus, generalized subcutaneous edema can occur during dermatomyositis, with facial edema as the initial symptom.
Collapse
Affiliation(s)
- Hiroaki Nishioka
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Japan
| | - Tatsuya Shindo
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Japan
| | - Hayato Shimizu
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Japan
| |
Collapse
|
4
|
Connolly CM, Xu L, Mecoli CA, Adler BL, Tiniakou E, Albayda J, Christopher-Stine L, Paik JJ. Bullous periorbital oedema in anti-p155/140-positive dermatomyositis: a case series. Rheumatology (Oxford) 2023; 62:e237-e239. [PMID: 36749007 PMCID: PMC10393435 DOI: 10.1093/rheumatology/kead065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/16/2023] [Accepted: 01/24/2023] [Indexed: 02/08/2023] Open
Affiliation(s)
- Caoilfhionn M Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lillian Xu
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher A Mecoli
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brittany L Adler
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eleni Tiniakou
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jemima Albayda
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lisa Christopher-Stine
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie J Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
5
|
Gonzalez D, Gupta L, Murthy V, Gonzalez EB, Williamson KA, Makol A, Tan CL, Sulaiman FN, Shahril NS, Isa LM, Martín-Nares E, Aggarwal R. Anti-MDA5 dermatomyositis after COVID-19 vaccination: a case-based review. Rheumatol Int 2022; 42:1629-1641. [PMID: 35661906 PMCID: PMC9166182 DOI: 10.1007/s00296-022-05149-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/09/2022] [Indexed: 01/01/2023]
Abstract
Anti-MDA5 (Melanoma differentiation-associated protein 5) myositis is a rare subtype of dermatomyositis (DM) characterized by distinct ulcerative, erythematous cutaneous lesions and a high risk of rapidly progressive interstitial lung disease (RP-ILD). It has been shown that SARS-CoV-2 (COVID-19) replicates rapidly in lung and skin epithelial cells, which is sensed by the cytosolic RNA-sensor MDA5. MDA5 then triggers type 1 interferon (IFN) production, and thus downstream inflammatory mediators (EMBO J 40(15):e107826, 2021); (J Virol, 2021, https://doi.org/10.1128/JVI.00862-21 ); (Cell Rep 34(2):108628, 2021); (Sci Rep 11(1):13638, 2021); (Trends Microbiol 27(1):75-85, 2019). It has also been shown that MDA5 is triggered by the mRNA COVID-19 vaccine with resultant activated dendritic cells (Nat Rev Immunol 21(4):195-197, 2021). Our literature review identified one reported case of MDA5-DM from the COVID-19 vaccine (Chest J, 2021, https://doi.org/10.1016/j.chest.2021.07.646 ). We present six additional cases of MDA5-DM that developed shortly after the administration of different kinds of COVID-19 vaccines. A review of other similar cases of myositis developing from the COVID-19 vaccine was also done. We aim to explore and discuss the evidence around recent speculations of a possible relation of MDA5-DM to COVID-19 infection and vaccine. The importance of vaccination during a worldwide pandemic should be maintained and our findings are not intended to discourage individuals from receiving the COVID-19 vaccine.
Collapse
Affiliation(s)
- Daniel Gonzalez
- Division of Rheumatology, University of Texas, Medical Branch, 301 University Boulevard, Route 1118, Galveston, TX, 77555, USA.
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Trust, Wolverhampton, UK
| | - Vijaya Murthy
- Division of Rheumatology, University of Texas, Medical Branch, 301 University Boulevard, Route 1118, Galveston, TX, 77555, USA
| | - Emilio B Gonzalez
- Division of Rheumatology, University of Texas, Medical Branch, 301 University Boulevard, Route 1118, Galveston, TX, 77555, USA
| | | | - Ashima Makol
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Chou Luan Tan
- Department of Rheumatology, Hospital Putrajaya, Putrajaya, Malaysia
| | | | | | - Liza Mohd Isa
- Department of Rheumatology, Hospital Putrajaya, Putrajaya, Malaysia
| | - Eduardo Martín-Nares
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
6
|
Suzuki I, Nakao R, Unai Y, Miyazaki Y. [A case of anti-SRP antibody-positive immune-mediated necrotizing myopathy triggered by human parvovirus B19 infection]. Rinsho Shinkeigaku 2022; 62:363-368. [PMID: 35474284 DOI: 10.5692/clinicalneurol.cn-001684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We have reported a case of a 44-year-old woman with anti-signal recognition particle (SRP) antibody-positive immune-mediated necrotizing myopathy triggered by human parvovirus B19 (PVB19) infection. She was admitted to the hospital because of lower leg edema and muscle weakness after erythema infectiosum. Magnetic resonance imaging of the lower extremities revealed high signals in the proximal muscles and subcutaneous edema on STIR. Muscle biopsy showed myofiber regenerative changes and variation in fiber size. A myositis-specific autoantibody profile indicated a positive result for anti-SRP antibodies. We diagnosed the patient with immune-mediated necrotizing myopathy (IMNM). Muscle strength and subcutaneous edema improved gradually in 3 months following immunotherapy. This is the first case report of an IMNM associated with PVB19 infection.
Collapse
Affiliation(s)
- Iku Suzuki
- Department of Neurology, Hyogo Prefectural Awaji Medical Center
| | - Ryohei Nakao
- Department of Neurology, Hyogo Prefectural Awaji Medical Center
| | - Yuki Unai
- Department of Neurology, Hyogo Prefectural Awaji Medical Center
| | | |
Collapse
|
7
|
Rare cutaneous toxicity of immune checkpoint inhibitors: A case of durvalumab-induced dermatomyositis. Eur J Cancer 2021; 155:25-27. [PMID: 34332401 DOI: 10.1016/j.ejca.2021.06.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/24/2021] [Indexed: 01/23/2023]
|
8
|
Coustal C, Du-Thanh A, Roubille F, Assenat E, Maria A. Une dermatomyosite inhabituelle sous inhibiteurs du checkpoint immunologique. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|