Pulmonary involvement

A Case of Hypomyopathic Dermatomyositis Associated with Rapid Progressive Interstitial Pneumonia Resistant to Multi-immunosuppressive Therapy

The prognosis of interstitial pneumonia in patients with dermatomyositis is thought to depend on the histologic type and response to therapy. We report a case of hypomyopathic dermatomyositis with rapid development of a fatal interstitial pneumonia. Although the histology of lung biopsy indicated minimal alveolitis, the patient died despite multi-immunosuppressive therapy. The autopsy revealed acute and organizing diffuse alveolar damage. In this case, the lung biopsy taken before the acute deterioration did not predict the patient's poor prognosis. Interstitial pneumonia in patients with amyopathic or hypomyopathic dermatomyositis would develop rapidly progressive and refractory. We need larger and better prospective studies to determine whether early and intensive immunosuppressive therapy improves the prognosis of interstitial pneumonia in patients with amyopathic or hypomyopathic dermatomyositis.

Outcome of patients having dermatomyositis admitted to the intensive care unit

Patients having systemic rheumatic diseases constitute a small percentage of admissions to the medical intensive care units (ICUs). Dermatomyositis (DM) is one of the rheumatic diseases that have secondary complications that may lead to a critical illness requiring hospitalization in the ICU. Herein, we present the features, clinical course, and outcome of critically ill patients having DM who were admitted to the ICU. The medical records of six DM patients admitted to the ICU in a large tertiary hospital in a 12-year period were reviewed. The mean age of patients at time of admission to the ICU was 38 (range 16-37). Mean disease duration from diagnosis to admission to the ICU was 1.6 years (range 1 month-8 years), while the main reason for admission to the ICU was acute respiratory failure. Two of six patients died during the hospitalization. The main causes of death were respiratory complications and sepsis. The outcome of DM patients admitted to the ICU was generally not different from the outcome of other patients hospitalized in the ICU. The main reason for hospitalization was acute respiratory failure. As there are many reasons for respiratory failure in DM, an early diagnosis and aggressive appropriate treatment may help to further reduce the mortality in these patients.