Fatal interstitial pneumonia in juvenile dermatomyositis.
A 5-year-old girl presented with a two-month-history of skin rash and general fatigue. She had a slight fever, progressive muscle weakness and liver dysfunction. Gottron's papules on her fingers and purple-reddish papules on her elbows were noted. Serum aldolase levels were highly elevated, however, creatine phosphokinase levels were normal. An MRI revealed abnormal high signal changes in her gluteus minimus muscles. Interstitial pneumonia suddenly developed and she died despite aggressive treatment with methylprednisolone pulse therapy followed by intravenous administration of cyclophosphamide, immunoglobulin and cyclosporine A. Interstitial pneumonia is rare in juvenile dermatomyositis; however, as in adult cases, it can be fatal. In order to prevent severe complications and functional disabilities, early aggressive treatments should be considered when muscle inflammation is refractory to ordinary treatment.
Nagai
Yayoi
Y
Department of Dermatology, Gunma University Graduate School of Medicine, and Department of Pediatrics, Gunma Central General Hospital, Gunma, Japan. yanagai@showa.gunma-u.ac.jp
Mizuno
Takahisa
T
Yoshizawa
Chikage
C
Ishikawa
Osamu
O
D002675:Child, Preschool; D003520:Cyclophosphamide / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D003882:Dermatomyositis / Q000150:complications*; D017809:Fatal Outcome; D005260:Female; D005634:Fructose-Bisphosphate Aldolase / Q000097:blood; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017563:Lung Diseases, Interstitial / Q000150:complications* / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D008775:Methylprednisolone / Q000627:therapeutic use; D018482:Muscle, Skeletal / Q000473:pathology; D020551:Pulse Therapy, Drug
D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003520:Cyclophosphamide; D005634:Fructose-Bisphosphate Aldolase; D008775:Methylprednisolone