inflammatory myopathy and acquired immunodeficiency syndrome

Abstract

A 33-year-old black woman with advanced acquired immunodeficiency syndrome (AIDS) presented with rapidly progressive muscle weakness and serologic and radiologic evidence of central nervous system Toxoplasma infection. Muscle biopsy revealed an inflammatory infiltrate predominantly composed of macrophages and T suppressorkytotoxic cells. Human immunodeficiency virus major core protein (p24) was also detected in macrophages and damaged muscle cells around the inflammatory infiltrates. The patient improved clinically with glucocorticoid therapy for polymyositis and pyrimethamine and clindamycin therapy for toxoplasmosis.In patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC), the musculoskeletal system may be involved secondary to peripheral neuropathy, by direct infection, or by an autoimmune inflammatory process (1-9). The etiology of polymyositis in patients with acquired immunodeficiency is unknown, although other autoimmuneThe opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

Rheumatic manifestations associated with human immunodeficiency virus infection

“…With the use of immunohistochemical techniques, HIV antigens have been demonstrated in synovial fluid and membrane of patients with reactive arthritis and psoriatic arthritis, in muscle from patients with polymyositis and dermatomyositis, and in vasculitic lesions (20,29). These HIV antigens may conceivably stimulate immune cells, resulting in the triggering of an immune reaction and eventual tissue damage.…”

“…Since the first description in 1983 (14), several reports have confirmed the association of polymyositis with HIV infection (1, [15][16][17][18][19][20]. The muscular involvement may appear months or years after clinical evidence of immunodeficiency, or may be the only manifestation of HIV infection (16).…”

“…The inflammatory cell infiltrate is composed of CD8 suppressor and CD4 helper lymphocytes in addition to B lymphocytes. HIV antigen p24 has been demonstrated in CD4 + cells, macrophages, and degenerated muscle cells (20). Viral-like particles and tubuloreticular structures have also been seen in the inflammatory infiltrates, even when viral cultures were negative (20).…”

“…HIV antigen p24 has been demonstrated in CD4 + cells, macrophages, and degenerated muscle cells (20). Viral-like particles and tubuloreticular structures have also been seen in the inflammatory infiltrates, even when viral cultures were negative (20). In a recent report of a patient with polymyositis and HIV and human T cell lymphotropic virus type I (HTLV-I) infection, HTLV-I was demonstrated on muscle biOf the case reports of patients with HIV-related polymyositis, most had not received zidovudine (AZT) therapy.…”

Human immunodeficiency virus–associated polymyositis: A longitudinal study of outcome

“…HIV‐associated polymyositis is clinically and histologically indistinguishable from an autoimmune polymyositis (14). In addition to this, HIV‐infected individuals have been diagnosed with infectious myopathies (excluding pyomyositis) due to microsporidiosis (16), cryptococcus neoformans (17), and toxoplasmosis (18). Although many cases of polymyositis attributed to HIV have been described, the prevalence, pathogenesis, clinical course, and appropriate therapy remain unclear.…”