Srpski arhiv za celokupno lekarstvo 2005 Volume 133, Issue Suppl. 2, Pages: 137-140
https://doi.org/10.2298/SARH05S2137R
Full text ( 852 KB)
Cited by
Systemic lupus erythematosus and dermatomyositis: Case report
Ristić Gorica (Military Medical Academy, Department of Rheumatology and Clinical Immunology, Belgrade)
Paunić Zoran (Military Medical Academy, Department of Nephrology, Belgrade)
Vojvodić Danilo (Military Medical Academy, Institute for Medical Research, Belgrade)
Petronijević Milan (Military Medical Academy, Department of Rheumatology and Clinical Immunology, Belgrade)
Glišić Branislava (Military Medical Academy, Department of Rheumatology and Clinical Immunology, Belgrade)
Stefanović Dušan (Military Medical Academy, Department of Rheumatology and Clinical Immunology, Belgrade)
The association of systemic lupus erythematosus (SLE) with idiopathic
polymyositis or dermatomyositis is reported to occur in the range of 4-16%.
Myositis can occur before or after SLE, or sporadically both diseases can be
present simultaneously. This case report concerns a 36-year-old female
patient suffering from Raynaud’s phenomenon, polyarthralgia in the small
joints of the hands, and skin changes compatible with Gotron’s indications.
Symmetric proximal muscle weakness of the extremities, fever of up to 40єC,
heliotrope rashes with erythematous changes in the face, upper arms, and
posterior shoulders occurred subsequently. Laboratory analyses revealed
increased acute phase reactants, hypochromic anaemia, lymphopenia, and
increased levels of all muscle enzymes. Immunoserology demonstrated positive
ANA, anti-Sm, and anticardiolipin antibodies (aCL), while anti dsDNA, anti
Ro, anti La, and anti Jo-1 antibodies proved negative. Hypocomplementaemia
and elevated levels of immune complexes were also detected. Pathologic
sediment and proteinuria were revealed via urine analyses, while a kidney
biopsy confirmed lupus nephritis (type IVa according to the World Health
Organisation classification). Biopsy of erythematous changes of the posterior
shoulder demonstrated leukocytoclastic vasculitis. Electromyography of the
lower extremities established myopathic changes. Inflammation of the muscles
was confirmed via magnetic resonance imaging. The patient was categorised as
having two separate coexistent diseases - SLE and dermatomyositis. Both the
classification criteria of the American College of Rheumatology for SLE and
the diagnostic criteria for dermatomyositis, proposed by Bohon and Peter,
were fulfilled simultaneously. Treatment commenced with pulses of
methylprednisolone and continued with oral therapy, including Resochin.
Pulses of intravenous cyclophosphamide were also administered. After six
weeks of therapy, biohumoral remission of both diseases was achieved, while
complete recovery from muscle weakness was accomplished after four months.
Keywords: systemic lupus erythematosus, dermatomyositis, polymyositis