Rapidly progressing treatment resistant anti-TIF1 gamma antibody positive dermatomyositis

Authors

  • Nidin Mohan Department of Medicine, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
  • Dayanandan Yoganandan Department of Medicine, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
  • Kavitha Mohanasundaram Department of Rheumatology, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
  • Kandasamy V. Rajalakshmi Department of Medicine, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
  • S. Magesh Kumar Department of Medicine, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20220358

Keywords:

Dermatomyositis, Creatine phosphokinase, Electromyogram

Abstract

Dermatomyositis is an idiopathic inflammatory myositis involving progressive muscle weakness with skin manifestations. Incidence of dermatomyositis is 1 per 100,000 in general population. Diagnosis is based on characteristic skin rashes, progressive muscle weakness and elevated muscle enzymes levels (creatine phosphokinase). The diagnosis is confirmed by clinical examination, abnormal electromyogram and autoimmune workup. In this case report, we report a case of difficult to treat dermatomyositis with proximal muscle weakness in an elderly male patient with classical skin lesions. The patient was resistant to steroid and immunoglobulin therapy.

Author Biographies

Nidin Mohan, Department of Medicine, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India

Junior Resident/Postgraduate

Department of General Medicine 

Dayanandan Yoganandan, Department of Medicine, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India

Assistant Professor

Department of General Medicine

Kavitha Mohanasundaram, Department of Rheumatology, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India

Associate Professor

Department of Rheumatology

Kandasamy V. Rajalakshmi, Department of Medicine, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India

Professor

Department of General Medicine

S. Magesh Kumar, Department of Medicine, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India

Professor

Department of General Medicine

References

Callen JP, Wortmann RL. Dermatomyositis. Clin Dermatol. 2006;24:363-73.

Madan V, Chinoy H, Griffiths CE, Cooper RG. Defining cancer risk in dermatomyositis. Part I. Clin Exp Dermatol. 2009;34:451-5.

Gunawardena H, Betteridge ZE, McHugh NJ. Myositis-specific autoantibodies: Their clinical and pathogenic significance in disease expression. Rheumatology (Oxford). 2009;48:607-12.

Targoff IN, Mamyrova G, Trieu EP, Perurena O, Koneru B, O’Hanlon TP, et al. A novel autoantibody to a 155-kd protein is associated with dermatomyositis. Arthritis Rheum. 2006;54:3682-9.

Kaji K, Fujimoto M, Hasegawa M, Kondo M, Saito Y, Komura K, et al. Identification of a novel autoantibody reactive with 155 and 140 kDa nuclear proteins in patients with dermatomyositis: An association with malignancy. Rheumatology (Oxford). 2007;46:25-8.

Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts). N Engl J Med. 1975;292(7):344-7.

Fiorentino DF, Chung LS, Christopher-Stine L, Zaba L, Li S, Mammen AL, Rosen A, Casciola-Rosen L. Most patients with cancer-associated dermatomyositis have antibodies to nuclear matrix protein NXP-2 or transcription intermediary factor 1gamma. Arthritis Rheum. 2013;65(11):2954-62.

Tartar DM, Chung L, Fiorentino DF. Clinical significance of autoantibodies in dermatomyositis and systemic sclerosis. Clin Dermatol. 2018;36:508-24.

Marie I, Mouthon L. Therapy of polymyositis and dermatomyositis. Autoimmun Rev. 2011;11(1):6-13.

Mastaglia FL. Inflammatory muscle diseases. Neurol India. 2008;56:263-70.

Chiappetta N, Steier J, Gruber B. Rituximab in the treatment of refractory dermatomyositis. J Clin Rheumatol. 2005;11:264-6.

Sultan SM, Ng KP, Edwards JC, Isenberg DA, Cambridge G. Clinical outcome following B cell depletion therapy in eight patients with refractory idiopathic inflammatory myopathy. Clin Exp Rheumatol. 2008;26:887-93.

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Published

2022-02-23

Issue

Section

Case Reports