Association of anti-glomerular basement membrane antibody disease with dermatomyositis and psoriasis: case report

Abstract

CONTEXT: Anti-glomerular basement membrane (anti-GBM) antibody syndrome is characterized by deposition of anti-GBM antibodies on affected tissues, associated with glomerulonephritis and/or pulmonary involvement. This syndrome has been described in association with other autoimmune disorders, but as far as we know, it has not been described in association with dermatomyositis and psoriasis.CASE REPORT: A 51-year-old man with a history of dermatomyositis and vulgar psoriasis presented with a condition of sensitive-motor polyneuropathy of the hands and feet, weight loss of 4 kg, malaise and fever. On admission, he had been making chronic use of cyclosporin and antihypertensive drugs for three months because of mild arterial hypertension. Laboratory tests showed anemia and leukocytosis, elevated serum urea and creatinine and urine presenting proteinuria, hematuria, leukocyturia and granular casts. The 24-hour proteinuria was 2.3 g. Renal biopsy showed crescentic necrotizing glomerulonephritis with linear immunoglobulin G (IgG) deposits on the glomerular basement membrane by means of direct immunofluorescence, which were suggestive of anti-GBM antibodies. The patient was then treated initially with methylprednisolone and with monthly cyclophosphamide in the form of pulse therapy. RESUMOCONTEXTO: A síndrome do anticorpo anti-membrana basal glomerular (anti-MBG) é caracterizada pela deposição de anticorpos anti-MBG em tecidos afetados, associada à glomerulonefrite e/ou ao envolvimento pulmonar. Essa síndrome já foi descrita em associação a outras doenças autoimunes, mas até onde conhecemos, não há relatos de sua associação com dermatomiosite e psoríase. RELATO DE CASO:Um homem de 51 anos com antecedentes de dermatomiosite e psoríase vulgar apresentou quadro de polineuropatia sensitivomotora de mãos e pés, perda de 4 kg, adinamia e febre. À admissão estava em uso crônico de ciclosporina e de anti-hipertensivos há três meses devido a hipertensão arterial leve. Exames laboratoriais mostraram anemia e leucocitose, creatinina e ureia séricas elevadas e urina com proteinúria, hematúria, leucocitúria e cilindros granulosos. A proteinúria de 24 horas foi de 2,3 g. A biópsia renal revelou uma glomerulonefrite crescêntica necrotizante com depósitos lineares de imunoglobulina G (IgG) na MBG à imunofluorescência, sugestivos de anticorpos anti-MBG. O paciente foi então tratado inicialmente com metilprednisolona e com ciclofosfamida mensalmente na forma de pulsoterapia.

Secondary myopathy due to systemic diseases

“…FDG‐PET may show an increased tracer‐uptake in affected muscles . In a single case, psoriasis was associated with dermatomyositis and antibodies against the glomerular basement membrane .…”

Clinical characteristics and prognosis of pulmonary renal syndrome in West China

“…PAH is a severe condition characterized by chronic obstruction of small pulmonary arteries leading to progressive right heart failure and, ultimately, death. PAH is associated with poor survival rates and is commonly reported in patients with autoimmune diseases such as ANCA-associated vasculitis, systemic sclerosis (SSc), anti-GBM disease and SLE [17][18][19] . Twenty-eight percent of our patients were diagnosed with PAH; however, the univariate logistic regression analysis suggested that PAH was not a significant predictive factor for death or ESRD (P = 0.358, P = 0.797).…”

Co‐existence of Juvenile dermatomyositis and psoriasis vulgaris with fungal infection: A case report and literature review

“…Seven cases developed dermatomyositis prior to psoriasis, and psoriasis preceded in the rest of the cases. Besides these, one case coexisted with interstitial pneumonia, the other one coexisted with Hashimoto's thyroiditis, Sjogren syndrome, and another case coexisted with corticosteroid‐induced diabetes and systemic hypertension . Referring to the pathogenesis, sufficient evidence suggested that the dermatomyositis and psoriasis shared some common inflammatory pathways, including interferon (IFN)‐α/β‐induced response, INF‐γ, and tumor necrosis factor (TNF)‐α.…”