Severe damage of respiratory muscles in polymyositis

Аннотация

Objectives – to present a clinical case of polymyositis in a 55-year-old man. The patient was admitted with a diagnosis "transient ischemic attack", quickly followed by an acute respiratory failure, which required the continuous use of mechanical ventilation.   Other clinical symptoms included: a high diaphragm position up to the 4-th ribs, the concurrent purulent endobronchitis, bilateral pneumonia, pleurisy, multiple atelectasis, myocardial dysfunction with a decrease in ejection fraction to 46%, local hypokinesia according to EchoCG data.  Despite the severe condition of the patient, there was not registered any distinct impairment of the proximal limb muscles and an increase in creatinphosphokinase blood level.   The antinuclear myositis-specific antibodies, the signs of primary muscular damage according to the limb muscles ENMG data were also absent.  The paraneoplastic process was excluded. The results of clinical examination made the diagnosis of polymyositis uncertain.   To clarify the cause of the respiratory muscles damage, an intercostal muscle biopsy was performed.It revealed expressed changes in the muscle, with massive necrosis areas,  and perivascular lymphohistiocytic infiltration. 

Conclusion. The described case of polymyositis is extremely rare, has a severe course and is complicated for diagnosis and treatment. In this case, the most informative examination method can be a biopsy of the intercostal muscles, which allows to identify the inflammatory origine of the disease and to determine the pathogenetic therapy.

Abstract

Conflict of Interest: nothing to disclose.

Список литературы

1. Russian clinical recommendations. Rheumatology / ed. Nasonov EL. M.: GEOTAR-Media, 2017. (In Russ.).

2. Siba P, Anupam M. Polymyositis and dermatomyositis: Disease spectrum and classification. Indian J Dermatol. 2012;57 (5):366-370. doi:10.4103/0019-5154.100477

3. Hunter M., Telias I., Collado V, et al. Inflammatory myopathy with initial respiratory muscles involvement and rheumatoid arthritis. Medicina (B Aires). 2014;74(5):393-6.

4. Antelava OA, Bondarenko IB, Chichasova NV, Nasonov EL. Respiratory disorders in patients with polymyositis/dermatomyositis. Modern Rheumatology Journal. 2014;(1):31-38. (In Russ.). doi: 10.14412/1996-7012-2014-1-31-38

5. Zykova AS, Novikov PI, Moiseev SV. Adult dermatomyositis: new classification criteria and modern treatment. Clinical Pharmacology and Therapy. 2017;26(2):83-92. (In Russ.). doi 10.32756/0869-5490-2019-2

6. Antelava OA, Lyubimova EG, Palshina SG, at al. Development of comorbid infection in patients with polymyositis/dermatomyositis. Scientific and Practical Rheumatology. 2009;3:102-105. (In Russ.). doi: 10.14412/1995-4484-2009-1319

7. Shklyaev AE, Zamyatina SG, Gorbunov YuV, Ivanova LV. Features of a diagnostic search for dermatomyositis (clinical observation). Archive of Internal Medicine. 2017;7(6):469-473. (In Russ.). doi: 10.20514/2226-6704-2017-7-6-469-473

8. Dikareva EA, Velichinskaya OG. Dermatomyositis (clinical case). Vestnik of Vitebsk State Medical University. 2019;18(2):116-122. (In Russ.). doi: 10.22263/2312-4156.2019.2.116

9. Skryabina EN, Borodkin AV, Korotin AS. Diagnosis of defeat of the respiratory muscles in idiopathic inflammatory myopathies. Clinical discussion. Farmateka. 2013;19(272):108-111. (In Russ.).

10. Antelava OA, Nasonov EL. Modern methods for assessing activity and damage in idiopathic inflammatory myopathies. Scientific and Practical Rheumatology. 2007;1:59-62. (In Russ.). doi:10.14412/2074-2711-2014-3-56-65

11. Antelava OA, Nasonov EL. Idiopathic inflammatory myopathies: main clinical and immunological options, difficulties in the differential diagnosis and therapy. Clinical Medicine. 2014;3:19-25. (In Russ). doi:10.14412/1996-7012-2014-3-56-65

12. Antelava OA, Khelkovskaya-Sergeeva AN, Chichasova NV, Radenska-Lopovok SG. Myositis associated with malignant tumors. Rheumatology Science and Practice. 2016;54(3):289-298. (In Russ.). doi:10.14412/1995-4484-2016-289-298

13. Antelava OA, Starovoitova MN, Desinova OV, et al. Differential diagnosis of myopathic syndrome in dermatomyositis/polymyositis and progressive muscular dystrophies (description of a case). Modern rheumatology Journal. 2012;4:55-57. (In Russ.). doi: 10.14412/1996-7012-2012-763

14. Antelava OA, Lyubimova EG, Palshina SG, et al. Development of comorbid infection in patients with polymyositis/dermatomyositis. Rheumatology Science and Practice. 2009;3:102-105. (In Russ.).  doi:10.14412/1995-4484-2009-1319

15. Antelava OA, Radenska-Lopovok SG, Nasonov EL. Diagnostic criteria for idiopathic inflammatory myopathies. Problems of their optimization. Modern Rheumatology Journal. 2014; (3):56–65. doi: 10.14412/1996-7012-2014-3-56-65

Для цитирования

Scryabina EN, Magdeeva NA, Melehina IF, Alexandrova OL. Severe damage of respiratory muscles in polymyositisScience & Innovations in Medicine. 2019;4(4):53-57. doi: 10.35693/2500-1388-2019-4-4-53-57

Request

Send an online application form to the publication

Send