title: Two cases of autoimmune and secondary pulmonary alveolar proteinosis during immunosuppressive therapy in dermatomyositis with interstitial lung disease.
abstract: Interstitial lung disease (ILD) with dermatomyositis often requires intensive immunosuppressive therapy. Here, we report two cases of pulmonary alveolar proteinosis (PAP) in dermatomyositis with ILD. One case was secondary PAP, and the other was autoimmune PAP positive for the anti-granulocyte macrophage-colony-stimulating factor antibody. PAP arose during immunosuppressive therapy and symptoms ceased by attenuating immunosuppression. Exacerbation of pulmonary lesions during intensive immunosuppressive therapy may distinguish PAP from worsening ILD and attenuating immunosuppression should be considered.
authors.affiliation: a Department of Rheumatology and Clinical Immunology.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Imura
authors.affiliation: a Department of Rheumatology and Clinical Immunology.
authors.forename: Naoichiro
authors.initials: N
authors.lastname: Yukawa
authors.affiliation: b Department of Respiratory Medicine Graduate School of Medicine , Kyoto University , Sakyo-ku, Kyoto , Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Handa
authors.affiliation: a Department of Rheumatology and Clinical Immunology.
authors.forename: Ran
authors.initials: R
authors.lastname: Nakashima
authors.affiliation: a Department of Rheumatology and Clinical Immunology.
authors.forename: Kosaku
authors.initials: K
authors.lastname: Murakami
authors.affiliation: a Department of Rheumatology and Clinical Immunology.
authors.forename: Hajime
authors.initials: H
authors.lastname: Yoshifuji
authors.affiliation: a Department of Rheumatology and Clinical Immunology.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Ohmura
authors.affiliation: c Department of Respiratory Medicine , Kyorin University School of Medicine , Mitaka , Japan , and.
authors.forename: Haruyuki
authors.initials: H
authors.lastname: Ishii
authors.affiliation: d Bioscience Medical Research Center , Niigata University , Chuoku, Niigata , Japan.
authors.forename: Koh
authors.initials: K
authors.lastname: Nakata
authors.affiliation: a Department of Rheumatology and Clinical Immunology.
authors.forename: Tsuneyo
authors.initials: T
authors.lastname: Mimori
mesh_terms: D003882:Dermatomyositis / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D017563:Lung Diseases, Interstitial / Q000188:drug therapy* / Q000276:immunology; D008875:Middle Aged; D011649:Pulmonary Alveolar Proteinosis / Q000209:etiology* / Q000473:pathology
chemical_list: D007166:Immunosuppressive Agents; D016178:Granulocyte-Macrophage Colony-Stimulating Factor
keywords: Dermatomyositis; Granulocyte macrophage–colony-stimulating factor; Immunosuppression; Pulmonary alveolar proteinosis