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Mourot A, Mahone M, Manganas H, Bourré-Tessier J, Landon-Cardinal O. Anti-synthetase syndrome diagnosed during pregnancy: a case report and literature review. Scand J Rheumatol 2024; 53:229-232. [PMID: 38346225 DOI: 10.1080/03009742.2024.2308374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/18/2024] [Indexed: 04/13/2024]
Affiliation(s)
- A Mourot
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM), Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - M Mahone
- Division of Internal Medicine and Obstetrical Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - H Manganas
- Division of Respirology, Centre hospitalier de l'Université de Montréal (CHUM), Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - J Bourré-Tessier
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM), Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - O Landon-Cardinal
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM), Department of Medicine, Université de Montréal, Montréal, Québec, Canada
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2
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Dilbil M, Erbasan F, Aslan B, Öğüt TS, Nokay M, Yazısız V, Terzioğlu ME. Pneumomediastinum, pneumatosis intestinalis and pneumoperitoneum in a patient with polymyositis: case-based review. Rheumatol Int 2023; 43:771-776. [PMID: 36190526 DOI: 10.1007/s00296-022-05205-1] [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: 06/21/2022] [Accepted: 09/01/2022] [Indexed: 10/10/2022]
Abstract
Pneumomediastinum (PnM), pneumatosis intestinalis (PI), and pneumoperitoneum (PP) are rare complications of inflammatory myositis. We present a 59-year-old polymyositis (PM) patient who experienced all three complications simultaneously. The patient who presented with proximal muscle weakness, dysphagia, and weight loss was diagnosed with PM due to elevated muscle enzymes and consistent electromyography and muscle biopsy with inflammatory myopathy. On the 45th day of her immunosuppressive treatment, PnM, PI, and PP were detected incidentally in 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) scan performed for severe weight loss and treatment-resistant severe disease. Since the patient had no symptoms or signs of PnM and PP, no additional intervention was applied to the current treatment, and spontaneous regression was observed in the follow-up. In addition to this case, we reviewed patients with PM who developed PBM, PP, and PI in the literature.
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Affiliation(s)
- Melis Dilbil
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Akdeniz University, 07070, Antalya, Turkey
| | - Funda Erbasan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Akdeniz University, 07070, Antalya, Turkey.
| | - Bengisu Aslan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Akdeniz University, 07070, Antalya, Turkey
| | - Tahir Saygın Öğüt
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Akdeniz University, 07070, Antalya, Turkey
| | - Mine Nokay
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Akdeniz University, 07070, Antalya, Turkey
| | - Veli Yazısız
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Akdeniz University, 07070, Antalya, Turkey
| | - Mustafa Ender Terzioğlu
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Akdeniz University, 07070, Antalya, Turkey
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Tang K, Zhou J, Lan Y, Zhang H, Jin H. Pregnancy in adult-onset dermatomyositis/polymyositis: a systematic review. Am J Reprod Immunol 2022; 88:e13603. [PMID: 35867856 DOI: 10.1111/aji.13603] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/16/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022] Open
Abstract
Idiopathic inflammatory myopathy in pregnancy is uncommon but may result in complications for both mother and the fetus. In this systematic review, we summarized the current literature investigating outcomes of pregnancy related to the dermatomyositis/polymyositis (DM/PM) process. We searched PubMed, Embase, Cochrane Library, and Web of Science databases and included 61 studies reporting the disease course, pregnancy outcomes, and management of both pregnancy and DM/PM in the final analysis. The specific information of 221 pregnancies was extracted and these pregnancies were divided into three distinct forms: pregnancies after disease onset (n = 159), pregnancies with new disease onset (n = 37), and pregnancies followed by postpartum onset (n = 25). In most cases, DM/PM disease activity remained stable or improved throughout pregnancy (80.2%) and the postpartum period (83.9%). Active DM/PM during pregnancy significantly increased the risk of stillbirth or neonatal death (12% vs. 1%, P = 0.005) and preterm birth (34.7% vs. 11%, P<0.001). The rates of other poor outcomes (total fetal loss, low birth weight, and intrauterine growth retardation) were also increased in pregnancies with active disease. Mainstay treatments for active DM/PM during pregnancy are glucocorticoids and intravenous immunoglobins. The present results underline the importance of good control of myopathy in optimizing the pregnancy outcomes of women with DM/PM. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Keyun Tang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jia Zhou
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yining Lan
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hanlin Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hongzhong Jin
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Akiyama C, Shirai T, Sato H, Fujii H, Ishii T, Harigae H. Association of various myositis-specific autoantibodies with dermatomyositis and polymyositis triggered by pregnancy. Rheumatol Int 2021; 42:1271-1280. [PMID: 33837447 DOI: 10.1007/s00296-021-04851-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/27/2021] [Indexed: 01/05/2023]
Abstract
Although pregnancy is an important risk factor for autoimmune rheumatic diseases, little is known regarding the association between pregnancy and dermatomyositis (DM) or polymyositis (PM). Herein, we present two patients with DM that developed during the perinatal period. The first patient was positive for anti-aminoacyl synthetase (ARS) antibody and developed DM in the 14th week of pregnancy. Despite treatment, her foetus died of intrauterine growth restriction in the 27th week. The second patient was positive for anti-melanoma differentiation-associated gene 5 (MDA-5) antibody and developed DM 1 week after miscarriage at 9 weeks of gestation. The patient developed severe interstitial pneumonia, and intensive therapy including tofacitinib and rituximab administration was required. Our cases and a literature review revealed that various myositis-specific autoantibodies, including anti-ARS, anti-Mi-2, anti-TIF-1γ, and anti-MDA-5, are associated with DM and PM triggered by pregnancy. We also found that delay in commencing treatment in case of active disease including myositis and interstitial pneumonia, and poor response to corticosteroids were related to poor foetal outcomes in DM and PM. Although rare in pregnant women, it is critical to consider the possibility of DM and PM in patients presenting with rash, fever, weakness, and cough, and testing for myositis-specific autoantibodies is recommended.
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Affiliation(s)
- Chikaho Akiyama
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Tsuyoshi Shirai
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Hiroko Sato
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hiroshi Fujii
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Tomonori Ishii
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hideo Harigae
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
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Chen C, Chen Y, Huang Q, Hu Q, Hong X. Case Report: Rapidly Progressive Interstitial Lung Disease in A Pregnant Patient With Anti-Melanoma Differentiation-Associated Gene 5 Antibody-Positive Dermatomyositis. Front Immunol 2021; 12:625495. [PMID: 33717138 PMCID: PMC7947909 DOI: 10.3389/fimmu.2021.625495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/11/2021] [Indexed: 01/01/2023] Open
Abstract
Dermatomyositis occurs extremely rarely during pregnancy. A number of studies in the published literature have documented how the outcome of pregnancy is poor for both mother and fetus. The present case study reports on a patient who was diagnosed with clinically amyopathic dermatomyositis complicated by interstitial lung disease during pregnancy, and was successfully treated with a combined immunosuppressant regimen. To the best of the authors' knowledge, this is the first case study detailing how a pregnant woman with clinically amyopathic dermatomyositis with positive anti-melanoma differentiation-associated gene 5 antibody achieved complete remission after early intervention of combined immunosuppressive therapy without residual pulmonary interstitial changes.
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Affiliation(s)
| | | | | | | | - Xiaoping Hong
- Department of Rheumatology and Immunology, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
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Use of High-Flow Nasal Cannula Oxygen Therapy in a Pregnant Woman with Dermatomyositis-Related Interstitial Pneumonia. Case Rep Crit Care 2017; 2017:4527597. [PMID: 29464127 PMCID: PMC5804115 DOI: 10.1155/2017/4527597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/03/2017] [Accepted: 12/17/2017] [Indexed: 11/29/2022] Open
Abstract
A 33-year-old pregnant woman was referred to our hospital with respiratory distress at 30 weeks of gestation. Chest computed tomography (CT) scans revealed pulmonary infiltrates along the bronchovascular bundles and ground-glass opacities in both lungs. Despite immediate treatment with steroid pulse therapy for suspected interstitial pneumonia, the patient's condition worsened. Respiratory distress was slightly alleviated after the initiation of high-flow nasal cannula (HFNC) oxygen therapy (40 L/min, FiO2 40%). We suspected clinically amyopathic dermatomyositis (CADM) complicating rapidly progressive refractory interstitial pneumonia. In order to save the life of the patient, the use of combination therapy with immunosuppressants was necessary. The patient underwent emergency cesarean section and was immediately treated with immunosuppressants while continuing HFNC oxygen therapy. The neonate was treated in the neonatal intensive care unit. The patient's condition improved after 7 days of hospitalization; by this time, she was positive for myositis-specific autoantibodies and was diagnosed with interstitial pneumonia preceding dermatomyositis. This condition can be potentially fatal within a few months of onset and therefore requires early combination immunosuppressive therapy. This case demonstrates the usefulness of HFNC oxygen therapy for respiratory management as it negates the need for intubation and allows for various treatments to be quickly performed.
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Ochiai M, Sato E, Tanaka E, Tochihara M, Shimizu Y, Osawa H, Sidara K, Sugimoto N, Hoshi D, Kawaguchi Y, Taniguchi, A, Yamanaka H. Successful delivery in a patient with clinically amyopathic dermatomyositis during pregnancy despite first-trimester acute exacerbation of interstitial lung disease. Mod Rheumatol 2015; 27:364-368. [DOI: 10.3109/14397595.2014.975906] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Moeko Ochiai
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Eri Sato
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Eiichi Tanaka
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Mari Tochihara
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoko Shimizu
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hikota Osawa
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kumi Sidara
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Naoki Sugimoto
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Daisuke Hoshi
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasushi Kawaguchi
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsuo Taniguchi,
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
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