Pneumomediastinum and Subcutaneous Emphysema Associated with Fatal Interstitial Pneumonia in Dermatomyositis

Nagai, Yayoi; Ishikawa, Osamu; Miyachi, Yoshiki

doi:10.1111/j.1346-8138.1997.tb02825.x

Cited by 27 publications

(28 citation statements)

References 9 publications

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“…Myositis-associated rapidly progressive ILD has been reported in both classic DM and ADM/CADM patients [5-7,22-25]. Although rapidly progressive ILD often occurs in patients with ADM/CADM [5-7], its true incidence remains unknown due to poor estimates of the proportions of ADM/CADM patients in populations.…”

Section: Discussionmentioning

confidence: 99%

Myositis autoantibodies in Korean patients with inflammatory myositis: Anti-140-kDa polypeptide antibody is primarily associated with rapidly progressive interstitial lung disease independent of clinically amyopathic dermatomyositis

Kang

Nakashima

Mimori

et al. 2010

BMC Musculoskelet Disord

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BackgroundTo investigate the association between myositis autoantibodies and clinical subsets of inflammatory myositis in Korean patients.MethodsImmunoprecipitation was performed using the sera of classic polymyositis (PM) (n = 11) and dermatomyositis (DM) (n = 38) patients who met the Bohan and Peter criteria for definite inflammatory myositis. A panel of defined myositis autoantibodies was surveyed to investigate the association between each autoantibody and clinical subsets of inflammatory myositis.ResultsEither MSAs, anti-p140, or anti-p155/140 antibodies were found in 63.3% (31/49) of the study subjects. Anti-140-kDa-polypeptide (anti-p140) (18.4%, 9/49) and anti-155/140-kDa polypeptide (anti-p155/140) (16.3%, 8/49) antibodies were the most common, followed by anti-Mi2 (14.3%, 7/49), anti-ARS (12.2%, 6/49) and anti-SRP (2.0%, 1/49) antibodies. All MSAs and anti-p140 and anti-p155/140 antibodies were mutually exclusive. Anti-p140 (23.7%, 9/38), anti-p155/140 (21.1%, 8/38), and anti-Mi2 (18.4%, 3/38) antibodies were found exclusively in DM patients. Anti-p140 antibody was associated with rapidly progressive interstitial lung disease (ILD) (p = 0.001), with a sensitivity of 100.0% (4/4) and a specificity of 85.3% (29/34) in DM patients. Anti-p155/140 antibody was associated with cancer-associated DM (p = 0.009), with a sensitivity of 55.6% (5/9) and a specificity of 89.7% (26/29). Cancer-associated survival was significantly worse when anti-p155/140 antibody was present (19.2 ± 7.6 vs. 65.0 ± 3.5 months, p = 0.032). Finally, anti-ARS antibodies were associated with stable or slowly progressive ILD in PM and DM patients (p = 0.005).ConclusionsAnti-p140 and anti-p155/140 antibodies were commonly found autoantibodies in Korean patients with inflammatory myositis. Despite the lack of clinically amyopathic DM patients in the study subjects, a strong association was observed between anti-p140 antibody and rapidly progressive ILD. Anti-p155/140 antibody was associated with cancer-associated myositis and poor survival.

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Section: Discussionmentioning

confidence: 99%

Myositis autoantibodies in Korean patients with inflammatory myositis: Anti-140-kDa polypeptide antibody is primarily associated with rapidly progressive interstitial lung disease independent of clinically amyopathic dermatomyositis

Kang

Nakashima

Mimori

et al. 2010

BMC Musculoskelet Disord

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“…The risk factors for the pneumomediastinum in patients with DM include interstitial lung disease [4,6], cutaneous vasculopathy [7,9], mild or absent CK elevation [3,7,8], younger age [7] and steroid treatment [6,7]. Our patient was young and his CK levels were within the normal limits when the pneumomediastinum developed.…”

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confidence: 97%

Pneumomediastinum and subcutaneous emphysema associated with dermatomyositis

Korkmaz¹,

Özkan²,

Akay³

et al. 2001

Rheumatology

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Rheumatology 2001;40:476±478Pneumomediastinum and subcutaneous emphysema associated with dermatomyositis SIR, Dermatomyositis (DM) is a generalized disorder characterized by myositis and typical cutaneous ®nd-ings. The lung is frequently affected, usually by interstitial pneumonitis [1]. Spontaneous pneumomediastinum has also been reported as a rare complication in DM [2± 4]. Here we describe a patient with DM who developed interstitial pneumonitis complicated by pneumomediastinum and subcutaneous emphysema during steroid therapy.A 28-yr-old man was seen in another hospital in December 1999 with complaints of general fatigue, anorexia, fever, symmetrical arthritis of the hands and erythema of the ®ngers and face. Laboratory examination showed haemoglobin 9 gudl, white blood cell (WBC) count 8300umm 3 , erythrocyte sedimentation rate (ESR) 30 mmuh, aspartate transaminase (AST) 93 Uul (normally <37), alanine transaminase (ALT) 49 Uul (normally <42), lactate dehydrogenase (LDH) 1227 Uul (normal range 225± 450), creatine kinase (CK) 287 Uul (normal range 24 ±190). Tests for antinuclear antibodies (ANA), anti-Jo-1 and rheumatoid factor were negative. Electroneuromyography showed myopathic abnormalities; biopsy specimens of the right deltoid muscle revealed degeneration of muscle ®bres and a mild degree of mononuclear cell in®ltration. Chest radiography showed a mild alveolar and interstitial

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“…The risk factors for SSE and other air leak syndromes in systemic connective tissue diseases include ILD,11 12 cutaneous vasculopathy,13 rheumatoid nodules5 and steroid treatment 12 13. Our patient manifested with rapidly progressing swelling around the neck extending into the face and anterior chest with only minimal added discomfort ascribable to the SE.…”

Section: Discussionmentioning

confidence: 75%

Recurrent spontaneous subcutaneous emphysema in a patient with rheumatoid arthritis

2015

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Pulmonary air leak syndromes are extremely rare complications of systemic autoimmune connective tissue diseases and the occurrence of spontaneous subcutaneous emphysema (SSE) from pulmonary leak in the absence of pneumothorax or pneumomediastinum is even rarer. We report a case of recurrent SSE in a patient with rheumatoid arthritis and interstitial lung disease. The SSE was managed conservatively each time and it resorbed over several days. There has been no previous documented report of SSE in the absence of pneumomediastinum, pneumothorax or pulmonary nodules in a patient with RA.

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Pneumomediastinum and Subcutaneous Emphysema Associated with Fatal Interstitial Pneumonia in Dermatomyositis

Cited by 27 publications

References 9 publications

Myositis autoantibodies in Korean patients with inflammatory myositis: Anti-140-kDa polypeptide antibody is primarily associated with rapidly progressive interstitial lung disease independent of clinically amyopathic dermatomyositis

Myositis autoantibodies in Korean patients with inflammatory myositis: Anti-140-kDa polypeptide antibody is primarily associated with rapidly progressive interstitial lung disease independent of clinically amyopathic dermatomyositis

Pneumomediastinum and subcutaneous emphysema associated with dermatomyositis

Recurrent spontaneous subcutaneous emphysema in a patient with rheumatoid arthritis

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