title: Immune-mediated myositis in Crohn's disease.
abstract: We report a patient with uncontrolled Crohn's disease who presented with progressive weakness of proximal muscles and a marked elevation of serum creatine kinase. Muscle biopsy from the left deltoid exhibited myositic changes with inflammatory infiltrates in the perimysium, endomysium, and perivascular locations. Most were stained as CD68-positive macrophages, whereas some were CD4- and CD8-positive T lymphocytes. Due to uncontrolled bowel inflammation, several fistulae were found in the descending colon, and partial colectomy was performed. An examination of the resected colon exhibited inflammation of the bowel structure surrounded mainly by CD68-positive macrophages. The histopathological findings of the descending colon were analogous to those of the muscle. After an increased dose of mesalazine and partial colectomy, her muscle symptoms improved. These findings suggest that the myositis in Crohn's disease is immune-mediated and that treatment of bowel inflammation should be emphasized as opposed to steroid or other immunosuppressive therapy.
authors.affiliation: Department of Neurology, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Shimoyama
authors.forename: Yohei
authors.initials: Y
authors.lastname: Tamura
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Kiyoharu
authors.initials: K
authors.lastname: Inoue
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D015703:Antigens, CD / Q000276:immunology; D015214:Antigens, Differentiation, Myelomonocytic / Q000276:immunology; D001706:Biopsy; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology / Q000276:immunology; D003082:Colectomy; D003106:Colon / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D003402:Creatine Kinase / Q000032:analysis / Q000097:blood; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D004576:Electromyography; D005260:Female; D006801:Humans; D008213:Lymphocyte Activation / Q000276:immunology; D008264:Macrophages / Q000166:cytology / Q000276:immunology; D008279:Magnetic Resonance Imaging; D019804:Mesalamine / Q000008:administration & dosage; D018908:Muscle Weakness / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000276:immunology / Q000473:pathology* / Q000503:physiopathology*; D009220:Myositis / Q000276:immunology / Q000473:pathology* / Q000503:physiopathology*; D009334:Neck Muscles / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D016896:Treatment Outcome; D000097382:CD68 Molecule
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D003402:Creatine Kinase; D019804:Mesalamine; C067980:CD68 antigen, human; D000097382:CD68 Molecule