Myopathy in a 61-year-old Hispanic man

Abstract

A 61-year-old Hispanic man presented to a county hospital for subacute progressive weakness, heliotrope rash and dysphagia. There was initial suspicion for dermatomyositis (DM) given the history; however, the physical exam was not consistent. An MRI followed by a muscle biopsy revealed necrotising autoimmune myositis and anti-3-hydroxy-3-methylglutary-coenzyme A-reductase antibody titers returned positive; the patient was diagnosed with necrotising autoimmune myositis. He was treated with corticosteroids and intravenous immunoglobulin, which resulted in improvement in his weakness and functional status. This case represents a unique instance in which a cardinal feature of DM, the heliotrope rash, prompted an erroneous initial diagnosis. It highlights the necessity of developing abroad differential diagnosis and subsequent thorough investigation into patients presenting with suspected idiopathic immune-mediated myopathies.

Treatment with intravenous immunoglobulins in systemic lupus erythematosus: a single-center experience with 63 patients

“…22,23 In our study, there was a notorious improvement in the SLEDAI-2K scores when compared to partially improved SLEDAI-2K scores in one patient with SLE and myositis in a previous study. 12 On the other hand, several case reports and evidence of IVIG in isolated inflammatory myopathies have been described, 24,25 suggesting IVIG’s benefits where muscular involvement is present. On the other hand, literature about IVIG in gastrointestinal manifestations is restricted to case reports with satisfactory outcomes when these are indicated as adjuvant or third-line therapy.…”