Acute lyme infection presenting with amyopathic dermatomyositis and rapidly fatal interstitial pulmonary fibrosis: a case report

Abstract

IntroductionDermatomyositis has been described in the setting of lyme infection in only nine previous case reports. Although lyme disease is known to induce typical clinical findings that are observed in various collagen vascular diseases, to our knowledge, we believe that our case is the first presentation of acute lyme disease associated with amyopathic dermatomyositis, which was then followed by severe and fatal interstitial pulmonary fibrosis only two months later.Case presentationWe present a case of a 64-year-old African-American man with multiple medical problems who was diagnosed with acute lyme infection after presenting with the pathognomonic rash and confirmatory serology. In spite of appropriate antimicrobial therapy for lyme infection, he developed unexpected amyopathic dermatomyositis and then interstitial lung disease.ConclusionsThis case illustrates a potential for lyme disease to produce clinical syndromes that may be indistinguishable from primary connective tissue diseases. An atypical and sequential presentation (dermatomyositis and interstitial lung disease) of a common disease (lyme infection) is discussed. This case illustrates that in patients who are diagnosed with lyme infection who subsequently develop atypical muscular, respiratory or other systemic complaints, the possibility of severe rheumatological and pulmonary complications should be considered.

Environmental triggers of dermatomyositis: a narrative review

“…Streptococcus pyogenes (59) Mycobacterium tuberculosis (60) Borrelia burgdorferi (61) Ultraviolet radiation (62)(63)(64)(65)(66)(67)(68)(69)(70) Environmental pollution Silica (71)(72)(73) Dust (biological, mineral, gases/fumes) (74) Particulate matter (vehicle/industrial emissions) (75)(76)(77)(78) Cigarette smoking (79,80) Maternal exposure (associated with JDM): Chalk dust, gasoline vapor, maternal smoking, carbon monoxide (81) deemed essential for the goals of this review. We present the following article in accordance with the Narrative Review reporting checklist (available at http://dx.doi.org/10.21037/ atm-20-3719).…”

The Emergence of a Forgotten Entity: Dermatomyositis-like Presentation of Lyme Disease in Rural Wisconsin

“…In the literature, there is only one case similar to ours, when antibiotics led to the complete resolution of DM-like clinical features and required no steroids [ 6 ]. However, most of the cases needed both steroids and antibiotics for DM resolution [ 3 , 5 , 7 - 9 ]. So far, there is only one case reported by Arniaud et al [ 5 ] who was treated with IV methylprednisolone and cyclophosphamide but not with antibiotic treatment, though Lyme serology was positive.…”

“…However, most of the cases needed both steroids and antibiotics for DM resolution [ 3 , 5 , 7 - 9 ]. So far, there is only one case reported by Arniaud et al [ 5 ] who was treated with IV methylprednisolone and cyclophosphamide but not with antibiotic treatment, though Lyme serology was positive. Regarding antimicrobial therapy, Frey et al [ 10 ] supported a four-week treatment compared to two-week treatment.…”

State of the art

“…Another possible inducer of IIM is Borrelia burgdorferi, the bacterial agent of Lyme disease. A case report [44] describing the development of dermatomyositis after B. burgdorferi infection proposed this association. Supporting evidence for fungal infections as a trigger for IIM is limited.…”