[Case of dermatomyositis complicated with massive pleural effusion that preceded the myopathy].
A 36-year-old man was admitted to a hospital with complaints of fever, polyarthralgia and dyspnea. Erythema was observed on his face, extensor surface of the fingers and extremities, and a chest X-ray revealed massive bilateral pleural effusion. He had no sign of myopathy at this point. Pleural fluid was proved to be exudative and contained extremely high levels of hyaluronic acid. He was also complicated with interstitial pneumonitis and was given a pulse therapy with methyl prednisolone followed by daily administration of 55 mg prednisolone (PSL). Twenty days after the commencement of the therapy, pleural effusion decreased but muscle weakness gradually appeared, accompanied by elevation of myogenic enzymes. Myogenic changes on electromyogram, and irregularity of the muscle fibers with slight inflammatory cell infiltrates in a biopsy specimen were demonstrated. He was transferred to our hospital, and a diagnosis of dermatomyositis was made. Later, pleural effusion waxed and waned depending on the dosage of PSL, but no other causative disorder was demonstrated by extensive examinations. This case indicates that the pleuritis could be one of the vasculitic manifestations of dermatomyositis.
Department of Bioregulatory Medicine and Rheumatology, Tokyo Medical and Dental University Graduate School.
Hideyuki
H
Iwai
Ryuji
R
Koike
Jun
J
Ogawa
Takahiko
T
Sugihara
Hiroyuki
H
Hagiyama
Kenji
K
Nagasaka
Yoshinori
Y
Nonomura
Junko
J
Nishio
Toshihiro
T
Nanki
Rieko
R
Tsubata
Hitoshi
H
Kohsaka
Tetsuo
T
Kubota
Nobuyuki
N
Miyasaka
D000328:Adult; D015415:Biomarkers / Q000032:analysis; D003882:Dermatomyositis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D006801:Humans; D006820:Hyaluronic Acid / Q000032:analysis; D017563:Lung Diseases, Interstitial / Q000150:complications; D008297:Male; D009135:Muscular Diseases / Q000209:etiology*; D010996:Pleural Effusion / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D011239:Prednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives; D020551:Pulse Therapy, Drug
D015415:Biomarkers; C025429:methyl prednisolonate; D006820:Hyaluronic Acid; D011239:Prednisolone