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Wang QH, Chen LH. Treatment of refractory anti-melanoma differentiation-associated gene 5 anbibody-positive dermatomyositis complicated by rapidly progressing interstitial pulmonary disease: Two case reports. World J Clin Cases 2023; 11:5345-5351. [DOI: 10.12998/wjcc.v11.i22.5345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/30/2023] [Accepted: 07/04/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Anti-melanoma differentiation-associated gene 5 antibody-positive (anti-MDA5 Ab+) dermatomyositis complicated with rapidly progressive interstitial lung disease (anti-MDA5 Ab+ DM-RP-ILD) has an unclear underlying mechanism with no recommended unified treatment plan. Herein, one of the cases that we report (Case 2) was successfully treated with tocilizumab despite having lung infection.
CASE SUMMARY Case 1 was a 30-year-old woman who was admitted due to recurrent rash for 5 mo, fever and cough for 1 mo, and chest tightness for 3 d. She was diagnosed with non-myopathic dermatomyositis (anti-MDA5 Ab+) and interstitial pneumonia, and was treated with the combination of hormone therapy and cyclophosphamide followed by oral tacrolimus. Case 2 was a 31-year-old man admitted due to systemic rash accompanied by muscle weakness of limbs for more than 1 mo, and chest tightness and dry cough for 4 d. He was diagnosed with dermatomyositis (anti-MDA5 Ab+) and acute interstitial pneumonia with Pneumocystis jirovecii and Aspergillus fumigatus infections and was treated with hormone therapy (without cyclophosphamide) and the combination of tocilizumab and tacrolimus. The condition of both patients eventually improved and they were discharged and showed clinically stable condition at the latest follow-up.
CONCLUSION Tocilizumab could be a salvage treatment for patients with anti-MDA5 Ab+ DM-RP-ILD who are refractory to intensive immunosuppression.
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Affiliation(s)
- Qiao-Hong Wang
- Department of Rheumatology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Li-Heng Chen
- Department of Endocrinology, Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu 322000, Zhejiang Province, China
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2
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Wang QH, Chen LH. Treatment of refractory anti-melanoma differentiation-associated gene 5 anbibody-positive dermatomyositis complicated by rapidly progressing interstitial pulmonary disease: Two case reports. World J Clin Cases 2023; 11:5351-5357. [PMID: 37621599 PMCID: PMC10445068 DOI: 10.12998/wjcc.v11.i22.5351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/30/2023] [Accepted: 07/04/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Anti-melanoma differentiation-associated gene 5 antibody-positive (anti-MDA5 Ab+) dermatomyositis complicated with rapidly progressive interstitial lung disease (anti-MDA5 Ab+ DM-RP-ILD) has an unclear underlying mechanism with no recommended unified treatment plan. Herein, one of the cases that we report (Case 2) was successfully treated with tocilizumab despite having lung infection. CASE SUMMARY Case 1 was a 30-year-old woman who was admitted due to recurrent rash for 5 mo, fever and cough for 1 mo, and chest tightness for 3 d. She was diagnosed with non-myopathic dermatomyositis (anti-MDA5 Ab+) and interstitial pneumonia, and was treated with the combination of hormone therapy and cyclophosphamide followed by oral tacrolimus. Case 2 was a 31-year-old man admitted due to systemic rash accompanied by muscle weakness of limbs for more than 1 mo, and chest tightness and dry cough for 4 d. He was diagnosed with dermatomyositis (anti-MDA5 Ab+) and acute interstitial pneumonia with Pneumocystis jirovecii and Aspergillus fumigatus infections and was treated with hormone therapy (without cyclophosphamide) and the combination of tocilizumab and tacrolimus. The condition of both patients eventually improved and they were discharged and showed clinically stable condition at the latest follow-up. CONCLUSION Tocilizumab could be a salvage treatment for patients with anti-MDA5 Ab+ DM-RP-ILD who are refractory to intensive immunosuppression.
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Affiliation(s)
- Qiao-Hong Wang
- Department of Rheumatology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Li-Heng Chen
- Department of Endocrinology, Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu 322000, Zhejiang Province, China
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Schumacher F, Wollsching-Strobel M, Kroppen D, Schwarz SB, Strunk J, Windisch W, Berger M. [Treatment alternatives for amyopathic MDA5-positive dermatomyositis]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023:10.1007/s00108-023-01517-x. [PMID: 37249583 PMCID: PMC10366251 DOI: 10.1007/s00108-023-01517-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/31/2023]
Abstract
We report a case of an atypical course of therapy in amyopathic MDA5-antibody-positive dermatomyositis with interstitial lung disease. Due to the poor prognosis, early therapy with cyclophosphamide followed by rituximab was carried out initially in addition to the administration of prednisolone. Due to therapy failure, treatment was switched to mycophenolate mofetil. This showed a surprisingly rapid positive course in terms of interstitial lung disease, skin manifestation, and general disease activity.
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Affiliation(s)
- Falk Schumacher
- Klinik für Rheumatologie, Krankenhaus Porz am Rhein gGmbH, Urbacher Weg 19, 51149, Köln, Deutschland.
- Department Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland.
| | - Maximilian Wollsching-Strobel
- Lungenklinik Merheim, Kliniken der Stadt Köln GmbH, Köln, Deutschland
- Department Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland
| | - Doreen Kroppen
- Lungenklinik Merheim, Kliniken der Stadt Köln GmbH, Köln, Deutschland
- Department Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland
| | - Sarah Bettina Schwarz
- Lungenklinik Merheim, Kliniken der Stadt Köln GmbH, Köln, Deutschland
- Department Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland
| | - Johannes Strunk
- Klinik für Rheumatologie, Krankenhaus Porz am Rhein gGmbH, Urbacher Weg 19, 51149, Köln, Deutschland
| | - Wolfram Windisch
- Lungenklinik Merheim, Kliniken der Stadt Köln GmbH, Köln, Deutschland
- Department Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland
| | - Melanie Berger
- Lungenklinik Merheim, Kliniken der Stadt Köln GmbH, Köln, Deutschland
- Department Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland
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Bobirca A, Alexandru C, Musetescu AE, Bobirca F, Florescu AT, Constantin M, Tebeica T, Florescu A, Isac S, Bojinca M, Ancuta I. Anti-MDA5 Amyopathic Dermatomyositis-A Diagnostic and Therapeutic Challenge. Life (Basel) 2022; 12:1108. [PMID: 35892910 PMCID: PMC9329888 DOI: 10.3390/life12081108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 06/15/2023] Open
Abstract
Clinically amyopathic Dermatomyositis (CADM) is a rare subtype of idiopathic inflammatory myositis, associated with no muscular manifestations, which is more frequent in Asian women. Anti-melanoma differentiation-associated gene 5 (MDA5) antibodies are a recently discovered type of specific autoantibodies associated with myositis. The anti-MDA5 DM was initially described in Japan and later it was discovered that the target antigen was a protein implicated in the innate immune response against viruses, that is encoded by the melanoma differentiation-associated gene 5. Anti-MDA5 DM is characteristically associated with distinguished mucocutaneus and systemic manifestations, including skin ulcerations, palmar papules, arthritis, and interstitial-lung disease. Patients with anti-MDA5 positivity have a high risk of developing rapid progressive interstitial-lung disease (RP-ILD), with a poor outcome. As a result, despite high mortality, diagnosis is often delayed, necessitating increased awareness of this possible condition. Despite a severe course of lung disease and an increased mortality rate, there is currently no standard treatment. Recent insights based on observational studies and case reports support combined therapy with immunosuppressive drugs and corticotherapy, as soon as the symptoms appear. The aim of this paper is to describe anti-MDA5 DM, focusing on the recent literature about the unique clinical manifestations and therapeutic options, starting from a severe clinical case diagnosed in our Rheumatology Department.
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Affiliation(s)
- Anca Bobirca
- Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.B.); (M.B.); (I.A.)
- Department of Internal Medicine and Rheumatology, “Dr. Ion Cantacuzino” Clinical Hospital, 011437 Bucharest, Romania; (C.A.); (A.T.F.)
| | - Cristina Alexandru
- Department of Internal Medicine and Rheumatology, “Dr. Ion Cantacuzino” Clinical Hospital, 011437 Bucharest, Romania; (C.A.); (A.T.F.)
| | - Anca Emanuela Musetescu
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.E.M.); (A.F.)
| | - Florin Bobirca
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, “Dr. Ion Cantacuzino” Clinical Hospital, 050474 Bucharest, Romania
| | - Anca Teodora Florescu
- Department of Internal Medicine and Rheumatology, “Dr. Ion Cantacuzino” Clinical Hospital, 011437 Bucharest, Romania; (C.A.); (A.T.F.)
| | - Magdalena Constantin
- 2nd Department of Dermatology, Colentina Clinical Hospital, “Carol Davila” University of Medicine and Pharmacy, 020125 Bucharest, Romania;
| | - Tiberiu Tebeica
- Department of Histopathology, “Dr. Leventer Centre”, 011216 Bucharest, Romania;
| | - Alesandra Florescu
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.E.M.); (A.F.)
| | - Sebastian Isac
- Department of Physiology and Neuroscience, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Mihai Bojinca
- Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.B.); (M.B.); (I.A.)
- Department of Internal Medicine and Rheumatology, “Dr. Ion Cantacuzino” Clinical Hospital, 011437 Bucharest, Romania; (C.A.); (A.T.F.)
| | - Ioan Ancuta
- Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.B.); (M.B.); (I.A.)
- Department of Internal Medicine and Rheumatology, “Dr. Ion Cantacuzino” Clinical Hospital, 011437 Bucharest, Romania; (C.A.); (A.T.F.)
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McPherson M, Economidou S, Liampas A, Zis P, Parperis K. Management of MDA-5 Antibody Positive Clinically Amyopathic Dermatomyositis Associated Interstitial Lung Disease: A Systematic Review. Semin Arthritis Rheum 2022; 53:151959. [DOI: 10.1016/j.semarthrit.2022.151959] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/31/2021] [Accepted: 01/17/2022] [Indexed: 12/29/2022]
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Anti-MDA5 Antibody-Associated Clinically Amyopathic Dermatomyositis: Case Report and Literature Review. J Gen Intern Med 2021; 36:3865-3868. [PMID: 34561830 PMCID: PMC8475418 DOI: 10.1007/s11606-021-07131-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 09/02/2021] [Indexed: 11/04/2022]
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Gupta R, Kumar S, Gow P, Hsien-Cheng Chang L, Yen L. Anti-MDA5-associated dermatomyositis. Intern Med J 2020; 50:484-487. [PMID: 32270621 DOI: 10.1111/imj.14789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 07/11/2019] [Accepted: 07/28/2019] [Indexed: 11/26/2022]
Abstract
Anti-MDA5-associated dermatomyositis (MDA5-associated DM) is an uncommon presentation of idiopathic inflammatory myositis, typically amyopathic, associated with rapidly progressive, treatment refractory interstitial lung disease and poor prognosis, particularly in patients with concomitant rapidly progressive interstitial lung disease (RP-ILD). We report two cases of MDA5-associated DM with fatal outcome in one of the patients, despite 'aggressive triple therapy' for RP-ILD.
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Affiliation(s)
- Rajiv Gupta
- Department of Rheumatology, Middlemore Hospital, Auckland, New Zealand
| | - Sunil Kumar
- Department of Rheumatology, Middlemore Hospital, Auckland, New Zealand
| | - Peter Gow
- Department of Rheumatology, Middlemore Hospital, Auckland, New Zealand
| | | | - Linda Yen
- Department of Rheumatology, Middlemore Hospital, Auckland, New Zealand
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8
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Unilateral Eyelid Swelling as a Sign of Antimelanoma Differentiation–Associated Gene 5 (Anti-MDA5)-Antibody–Positive Dermatomyositis. Ophthalmic Plast Reconstr Surg 2018; 34:e209-e211. [DOI: 10.1097/iop.0000000000001258] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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