A case of dermatomyositis that developed after delivery: the involvement of pregnancy in the induction of dermatomyositis

Kanoh, Hideo; Izumi, Takahiro; Seishima, Mariko; Nojiri, Mari; Ichiki, Yoshiro; Kitajima, Yasuo

doi:10.1046/j.1365-2133.1999.03165.x

Cited by 46 publications

(20 citation statements)

References 16 publications

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“…Mosca et al cells circulating in the mother may to some extent be correlated with the development of autoimmune diseases in the mothers (4,15,16). Because the dermatomyositis was diagnosed during the first weeks of pregnancy in our patient, a correlation between fetomaternal cell trafficking and the pathogenesis of maternal disease does not seem likely.…”

Section: Discussionmentioning

confidence: 66%

Pregnant patient with dermatomyositis successfully treated with intravenous immunoglobulin therapy

Mosca¹,

Strigini²,

Carmignani³

et al. 2005

Arthritis & Rheumatism

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Introduction The idiopathic inflammatory myopathies (IIMs) comprise a heterogeneous group of diseases of unknown etiology characterized by chronic inflammation of the skeletal muscles. IIMs are rare in subjects of reproductive age and very few cases of pregnancy in women affected by IIMs have been reported in the literature. Furthermore, these have generally been associated with a poor pregnancy outcome and relapses of disease activity, suggesting a negative effect of pregnancy on disease activity and vice versa (1–7). Here we describe the case of a woman with classic dermatomyositis (DM) that developed at the beginning of her pregnancy. She was treated with intravenous immunoglobulin therapy (IVIG) and corticosteroids and was delivered of a healthy 3,180-gm boy at 35 weeks’ gestation. Case report A 32-year-old woman affected by dermatomyositis was referred to the Rheumatology Unit of Pisa University in June 2002, when she was 17 weeks pregnant. Disease onset dated to March 2002 with the appearance of diffuse myalgias, increasing proximal muscle weakness, and skin rash; blood tests at the time showed a marked increase in transaminases and creatine phosphokinase (CPK; 3,560 IU/liter, normal values 180 IU/liter). During the same timeframe, she underwent a pregnancy test, which proved positive. The patient was admitted to a local hospital where the diagnosis of DM was made on the basis of the findings of a heliotrope rash and Gottron’s papules, an increase in muscle enzyme plasma levels, and a positive electromyogram (8). Moderate-dose steroid therapy (methylprednisolone 40 mg/day) was instituted, with a prompt improvement of the serologic markers (CPK 1,836 IU/liter). After this initial positive response in May 2002, however, the patient presented with a progressive increase in muscle weakness, a worsening of the cutaneous manifestations, and a further increase in CPK levels (up to 3,650 IU/liter). Her steroid dosage was increased to 60 mg/day methylprednisolone and she was transferred to the Rheumatology Unit of the University of Pisa. Examination on admission revealed the presence of a heliotrope rash, Gottron’s papules, and severe proximal muscle weakness in the shoulder and hip girdles. There was no peripheral edema, and her blood pressure values and chest and cardiac examinations were normal. The results of her laboratory tests were as follows: CPK 1,163 IU/liter; aspartate aminotransferase 141 U/liter (normal values 45 U/liter), alanine aminotransferase 91 U/liter (normal values 45 U/liter), normal renal function, no proteinuria, and a negative Coombs test. She was positive for antinuclear antibodies by indirect immunofluorescence (1/160 with a diffuse pattern), whereas assays for anti-Ro/SSA, anti-La/SSB, anti-Sm, anti-RNP, and anti-Jo1 antibodies by CIE were negative as were anticardiolipin antibodies and lupus anticoagulant. Capillaroscopy showed the presence of diffuse abnormalities with a polydermatomyositis pattern. The obstetric evaluation was unr...

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Section: Discussionmentioning

confidence: 66%

Pregnant patient with dermatomyositis successfully treated with intravenous immunoglobulin therapy

Mosca¹,

Strigini²,

Carmignani³

et al. 2005

Arthritis & Rheumatism

View full text Add to dashboard Cite

show abstract

“…Dermatomyosite et grossesse Quelques cas de DM survenus à l'occasion d'une grossesse ont été décrits, avec 2 situations un peu différentes : soit la DM apparaît au cours de la grossesse et l'évolution est le plus souvent favorable en postpartum ; soit, plus rarement, la DM apparaît en postpartum [10]. Même si l'évolution de ces DM peut être spontanément favorable, un traitement est le plus souvent nécessaire [10,11].…”

Section: Myopathie Inflammatoire Révélée à L'occasion D'une Grossesseunclassified

“…Même si l'évolution de ces DM peut être spontanément favorable, un traitement est le plus souvent nécessaire [10,11]. Parmi les formes un peu plus inhabituelles rapportées, on peut signaler 1 cas de DM amyopathique ayant débuté pendant la grossesse, d'évolution spontanément et rapidement favorable dans le postpartum [12], et 1 cas de DM juvénile chez une patiente âgée de 14 ans, ayant débuté pendant la grossesse [13].…”

Section: Myopathie Inflammatoire Révélée à L'occasion D'une Grossesseunclassified

“…Trois cas de syndrome des antisynthé-tases isolés ont été décrits chez des femmes enceintes : un pendant le 3 e trimestre, provoquant une fausse couche, et répondant à la corticothérapie [17] ; et 2 apparus dans le postpartum après accouchements d'enfants mort-nés [18,19]. La détection d'anticorps antisynthétases et/ou un authentique syndrome clinique des antisynthétases peuvent être associés (ou fortement ressembler) à une DM, comme au cours de 2 cas révélés durant le 3 e trimestre de la grossesse [10,11]. Dans l'un…”

Section: Autres Myopathies Inflammatoires Et Syndromes De Chevauchementunclassified

“…Dans l'autre cas, la DM, associée également à la présence d'autoanticorps antiSSA et antiRNP, s'est aggravée rapidement dans le postpartum, mais avec une réponse favorable à la corticothérapie [10].…”

Section: Mise Au Pointunclassified

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