Dermatomyositis: A Rare Extra-intestinal Manifestation of Ulcerative Colitis

Abstract

Inflammatory myositis as an extra-intestinal manifestation of inflammatory bowel disease (IBD) is rare. Coexistence of immuno-mediated diseases in patients with IBD and myositis suggests a common etiopathogenic mechanism underlying these conditions. The current report refers to a rare case of a 45-year-old Korean female with ulcerative colitis (UC) who developed dermatomyositis. She presented with skin rash and proximal muscle weakness, and her disease activity of UC was in remission state. Electromyography, magnetic resonance imaging, and deltoid muscle biopsy were performed. She was diagnosed with dermatomyositis associated with UC and treatment with glucocorticoids and azathioprine resulted in improvement in muscle power and skin rash. Clinicians should be aware of this unusual extra-intestinal manifestation. (J Rheum Dis 2016;23:183-186)

Myositis as an Extraintestinal Manifestation of Ulcerative Colitis: A Case Report and Literature Review

“…However, there is an immune-mediated hypothesis proposing that bowel inflammation and mucosal damage lead to the release of antigens, which stimulate an immune response. Subsequently, these intestinal antigens induce antibody-forming immune complexes that can ultimately result in muscle injury [ 5 , 6 ]. Another possible mechanism suggests that myositis is due to an immune response initiated by an infectious agent such as the measles virus, herpes virus, paramyxovirus, or mycobacterium paratuberculosis present in the large bowel and striated muscles.…”

“…Finally, some authors have thought that therapy for IBD, including glucocorticoids or azathioprine, may be responsible for muscle injury. However, in this circumstance, inflammatory myopathy could be differentiated from steroid myopathy through a muscle biopsy [1][2][3][4][5][6].…”

“…Rarely, skeletal muscle involvement may also occur in the patients with inflammatory bowel disease (IBD). It is more closely associated with Crohn’s disease, as only a few cases worldwide have been reported with UC [ 6 - 8 ].…”