Skeletal muscle disorders associated with inflammatory bowel diseases: occurrence of myositis in a patient with ulcerative colitis and Hashimoto's thyroiditis—case report and review of the literature

Abstract

Ulcerative colitis (UC) and Crohn's disease are inflammatory bowel diseases often associated with extra-intestinal manifestations. Of these, neutrophilic dermatoses and arthropathies are the more frequently observed, while the occurrence of striated muscle disorders, namely, myositis, has been very rarely diagnosed in these kinds of patients. The coexistence of immuno-mediated diseases in patients with inflammatory bowel diseases and myositis suggests a common aetiopathogenetic mechanism underlying these conditions. The present report refers to a rare case of a 51-year-old female with UC and Hashimoto's thyroiditis who developed myositis.

Dermatomyositis: A Rare Extra-intestinal Manifestation of Ulcerative Colitis

“…UC appears to be less commonly associated with an inflammatory myopathy than Crohn's disease [3]. Dermatomyositis is a particularly rare EIM of UC.…”

“…Regarding disease activity, in some reported patients, myositis is associated with an acute exacerbation of IBD, but activity of bowel disease does not appear to be mandatory for the onset of myositis. In some IBD cases, myopathy was diagnosed in a quiescent phase [3], and the current patient was also in clinical remission of UC when symptoms of myositis appeared. However, symptoms associated with myositis, such as fever, myalgia, muscle fatigue, and weakness may be considered as a part of the clinical manifestations of IBD in patients with active disease.…”

“…However, symptoms associated with myositis, such as fever, myalgia, muscle fatigue, and weakness may be considered as a part of the clinical manifestations of IBD in patients with active disease. Thus, misinterpretation can occur in diagnosis of myopathy in association with disease activity of IBD and caution is required [3].…”

“…Common sites include the joints (arthritis/arthralgia), skin (erythema nodosum, pyoderma gangrenosum), and eyes (iritis, uveitis) [2], while muscular diseases such as myositis have rarely been reported. Only a few cases of myositis associated with UC have been described in the literature [3]. We report on a case of a middle-aged woman with quiescent UC who developed dermatomyositis responsive to combined treatment with glucocorticoid and immunosuppressive agent.…”

“…Physical examination was otherwise unremarkable, with normal vital signs. Laboratory tests showed the following: white blood cell count was 4,110/mm 3 , hemoglobin was 12.6 g/dL, and platelet count was 272,000/mm 3 . Creatine phosphokinase (CPK) was increased to 434 IU/L (26 to 174 IU/L) and lactate dehydrogenase (LDH) was increased to 624 IU/L (240 to 480 IU/L), while serum aldolase level was within normal range (＜7.5 U/L).…”