Challenges and insights: a case report on refractory dermatomyositis
DOI:
https://doi.org/10.18203/2349-3933.ijam20242324Keywords:
Dermatomyositis, Rituximab, IVIG, Refractory diseaseAbstract
Dermatomyositis is a rare inflammatory myopathy known for its unique skin symptoms and muscle inflammation leading to proximal muscle weakness. It can be classified as idiopathic, juvenile dermatomyositis, or amyopathic dermatomyositis in adults, and may be associated with solid organ tumors. The pathophysiology of the disease is most likely influenced by immune-related variables, but genetic and environmental factors may also play a significant role. The majority of patients who receive immunosuppressive medication treatment report success, but there are chances of relapse. We report a case of dermatomyositis relapse that is refractory to pulse therapy and methotrexate.
References
Lundberg IE, Fujimoto M, Vencovsky J, Aggarwal R, Holmqvist M, Christopher-Stine L, et al. Idiopathic inflammatory myopathies. Nat Rev Dis Primers. 2021;7(1):86.
Pokhrel S, Pardhe BD, Giri N, Pokhrel R, Paudel D. Classical dermatomyositis: a case report. Clin Cosmetic Investig Dermatol. 2020;123-6.
Callen JP. Dermatomyositis. The Lancet. 2000;355(9197):53-7.
Kovacs SO, Kovacs SC. Dermatomyositis. J Am Acad Dermatol. 1998;39(6):899-922.
Marvi U, Chung L, Fiorentino DF. Clinical presentation and evaluation of dermatomyositis. Indian J Dermatol. 2012;57(5):375.
Oddis CV, Aggarwal R. Treatment in myositis. Nat Rev Rheumatol. 2018;14(5):279-89.
Cherin P, Herson S, Wechsler B, Piette JC, Bletry O, Coutellier A, et al. Efficacy of intravenous gammaglobulin therapy in chronic refractory polymyositis and dermatomyositis: an open study with 20 adult patients. Am J Med. 1991;91(2):162-8.
Cobos GA, Femia A, Vleugels RA. Dermatomyositis: an update on diagnosis and treatment. Am J Clin Dermatol. 2020;21(3):339-53.
Aggarwal R, Loganathan P, Koontz D, Qi Z, Reed AM, Oddis CV. Cutaneous improvement in refractory adult and juvenile dermatomyositis after treatment with rituximab. Rheumatology. 2017;56(2):247-54.
Femia AN, Eastham AB, Lam C, Merola JF, Qureshi AA, Vleugels RA. Intravenous immunoglobulin for refractory cutaneous dermatomyositis: a retrospective analysis from an academic medical center. J Am Acad Dermatol. 2013;69(4):654-7.