Staphylococcus protein A-based extracorporeal immunoadsorption and thalidomide in the treatment of skin manifestation of dermatomyositis: a case report.
Cutaneous involvement in dermatomyositis can be the prevalent component of disease, failing to respond to adequate therapies for myositis. In this case report, we describe a patient affected by dermatomyositis, characterized by prevalent skin involvement, successfully treated with Staphylococcus protein A-based extracorporeal immunoadsorption (Immunosorba, Fresenius Medical Care AG & Co. KGaA, Bad Homburg, Germany) and thalidomide. The patient showed panniculitic ulcerative lesions of the skin, difficult to treat because of side effects or ineffectiveness of various therapies. Skin manifestations rapidly improved after introduction of immunoadsorption; The association of thalidomide allowed a good maintenance of these results until the remission of skin lesions, despite several infective complications of some residual ulcers. Considering the difficulties in the management of our patient, combined therapy with Immunosorba and thalidomide has allowed a good clinical response. If confirmed, the observed beneficial effects suggest that protein A-based immunoadsorption and thalidomide can represent an alternative option in dermatomyositis, especially when cutaneous manifestations are predominant.
Sebastiani
Marco
M
Department of Internal Medicine, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, Italy. marco.sebastiani@unimore.it
Puccini
Rodolfo
R
Manfredi
Andreina
A
Manni
Elisabetta
E
Colaci
Michele
M
Mattei
Paola
P
Barachini
Paolo
P
Ferri
Clodoveo
C
D000328:Adult; D003882:Dermatomyositis / Q000628:therapy*; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D007163:Immunosorbent Techniques; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D013205:Staphylococcal Protein A; D013792:Thalidomide / Q000627:therapeutic use*; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D013205:Staphylococcal Protein A; D013792:Thalidomide