Acute Hemorrhagic Myositis in Inflammatory Myopathy and Review of the Literature

Gelder, Howard Van; Wu, Kim; Gharibian, Nayiri; Patel, Dharmi; Clements, Philip J.; Heinze, Emil; Morris, Robert I.; Wong, Andrew L.

doi:10.1155/2014/639756

Cited by 6 publications

(7 citation statements)

References 14 publications

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“…Publications containing non-DM inflammatory myositis cases, cases without spontaneous bleeding, poster presentations, publications containing under-18 cases, and articles not written in English were excluded from analysis. Including 23 cases that met the inclusion criteria and our own case, total of 24 SIH patients were analyzed [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. We compared the data of these patients with our 41 DM patients without SIH.…”

Section: Laboratory Findings Of Our Dermatomyositis Cohort At the Tim...mentioning

confidence: 99%

“…From a diagnostic point of view, the most commonly used diagnostic method in patients was CT (87.5%). Magnetic resonance imaging (MRI) and USG were also used [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. When looking at the literature, angiography is used for diagnostic purposes, especially in patients with severe bleeding [5,14,16].…”

Section: Risk Factors For Death Due To Dermatomyositisassociated Spon...mentioning

confidence: 99%

“…Pneumomediastinum is a rare but still known complication in the course of DM, while DM-related spontaneous intramuscular bleeding (SIH) is very rarely defined and is not very well known among rheumatologists. So far only case reports have been identified in the literature [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. The frequency and risk factors of DM-related SIH are unknown.…”

Section: Introductionmentioning

confidence: 99%

“…Detailed hemorrhage-related characteristics of patients with spontaneous intramuscular hemorrhage (together with our patient and cases in the literature)[5][6][7][8][9][10][11][12][13][14][15][16][17][18] …”

mentioning

confidence: 99%

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Evaluation of the frequency and risk factors of spontaneous intramuscular hemorrhage associated with dermatomyositis

Cansu,

Yildirim,

Uludoğan

et al. 2024

Rheumatol Int

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Dermatomyositis (DM) is an idiopathic inflammatory myositis (IIM) characterized by skin manifestations and muscle involvement. Spontaneous intramuscular hemorrhage (SIH) is a fatal complication that is very rare in the course of DM, but not well known to rheumatologists. Our aim was to determine the frequency and possible risk factors of DM-related SIH. A retrospective analysis was conducted on a cohort of DM patients who were observed in the rheumatology department of the university hospital between 1998 and January 2024. The clinical, laboratory, radiological data of the patients and the treatments they received during the follow-up were analyzed. To determine possible risk factors for the development of SIH in the course of DM, our patients with DM were analyzed together with other rare SIH cases in the literature. The study included 42 of our DM patients. 32 of the patients (76.2%) were female. The median age of the patients was 53 (24–82) years, the median age of DM diagnosis of the patients was 47 (18–75) years, and the median duration of DM of the patients was 36 (2-276) months. 7.1% of patients had dysphagia, and 16.7% had intertitial lung disease (ILD). 5 (11.9%) patients were diagnosed with malignancy. The incidence rate of SIH development in our DM cohort was 0.238/100 patient years (95% CI 0.006–1.256). We tried to identify independent risk factors for SIH development by comparing our 41 DM patients without SIH with the data of patients with 23 DM-related SIH collected from the literature by adding our 1 patient (24 pts). Male sex (OR 4.97, 95% CI 1.66–14.92, p = 0.003), ILD presence (OR 9.71, 95% CI 2.99–31.47, p < 0.001), anti-MDA5 positivity (OR 16.0, 95% CI 1.60-159.3, p = 0.006), anti-Ro52 positivity (OR 11.6, 95% CI 2.93–46.34, p < 0.001), heparin use (OR 4.42, 95% CI 2.68–7.24, p < 0.001), intravenous immunoglobulin (IVIG) use (OR 11.7, 95% CI 2.26–60.54, p < 0.001), and steroid dose (OR 1.03, 95% CI 1.00-1.05, p = 0.005) were identified as risk factors for the development of SIH in the univariate analysis. The death rate due to hemorrhage was 50%. No single risk factor was found to be associated with death. As a result, SIH may occasionally arise in patients with DM. Rheumatologists should be aware that patients with dysphagia and/or ILD, who are on heparin, getting high doses of steroids, and test positive for anti-MDA5 and/or anti-Ro52 antibodies may develop SIH in the early stages of DM.

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Section: Laboratory Findings Of Our Dermatomyositis Cohort At the Tim...mentioning

confidence: 99%

Section: Risk Factors For Death Due To Dermatomyositisassociated Spon...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of the frequency and risk factors of spontaneous intramuscular hemorrhage associated with dermatomyositis

Cansu,

Yildirim,

Uludoğan

et al. 2024

Rheumatol Int

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“…It was reported that there are some biomarkers (such as endothelin and vWF) increased in MDA5 + DM patients with cutaneous ulcers, suggesting the correlation between MDA5 + DM and endothelial injury ( 32 ). A muscle biopsy of an anti-SSA/Ro-52-positive DM patient with SIH showed intravascular coagulation and capillary disruption ( 90 ). Another study on muscle pathology also showed capillary loss was apparent in non-MDA5 + DM patients, while interestingly tissue specimens showed reserved capillary density and infiltrated inflammation clustering focally in the perimysium around a single vessel in MDA5 + DM ( 100 ).…”

Section: Sih and Mda5 + Dmmentioning

confidence: 99%

Rare complications of anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis: Time to nip them in the bud

Yang

Yan

2022

Front. Immunol.

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Anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis (MDA5+ DM) is an infrequent autoimmune disease, which mainly distributes in Asians and females. MDA5+ DM usually presents various skin lesions and positive anti-MDA5 antibody (a myositis-specific autoantibody for itself) with amyopathic or hypomyopathic features. For MDA5+ DM patients, rapidly progressive interstitial lung disease is a common complication with a high-speed deterioration and a poor prognosis. Besides, there are other complications of MDA5+ DM patients, including pneumomediastinum, macrophage activation syndrome and spontaneous intramuscular hemorrhage. These complications were rare but lethal, so it is necessary to explore their diagnosis methods, therapies and potential mechanisms, which are helpful for early diagnoses and timely treatment. To date, several cases and studies have shown distinctive features, diagnoses and treatments of these three rare complications, and there are also some differences among them. In this review, we outlined the characteristics, administration and potential pathogenesis of these rare complications of MDA5+ DM.

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Dilemma in management of hemorrhagic myositis in dermatomyositis

et al. 2019

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Acute Hemorrhagic Myositis in Inflammatory Myopathy and Review of the Literature

Cited by 6 publications

References 14 publications

Evaluation of the frequency and risk factors of spontaneous intramuscular hemorrhage associated with dermatomyositis

Evaluation of the frequency and risk factors of spontaneous intramuscular hemorrhage associated with dermatomyositis

Rare complications of anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis: Time to nip them in the bud

Dilemma in management of hemorrhagic myositis in dermatomyositis

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