Opportunistic infections in polymyositis and dermatomyositis

Abstract

Objective. To assess prevalence and characteristics of opportunistic infections in patients with polymyositis/dermatomyositis (PM/DM). To determine the predictive values for opportunistic infections on clinical presentation, biochemical findings, and paraclinical features of PM/DM to detect patients at risk of opportunistic infections. Methods. The medical records of 156 consecutive PM/DM patients in 3 medical centers were reviewed. Results. Eighteen PM/DM patients (11.5%) developed opportunistic infections. The majority of patients exhibited an opportunistic infection after the onset of PM/DM (89% of cases). Opportunistic infections occurred most frequently during the first year following PM/DM diagnosis (62.5%). The pathogen microorganisms responsible for opportunistic infections were various, i.e., Candida albicans, Pneumocystis carinii, Aspergillus fumigatus, Geotrichum capitatum, Mycobacterium avium-intracellulare complex, M. xenopi, M. marinum, M. tuberculosis, Helicobacter heilmanii, cytomegalovirus, and herpes simplex virus. Mortality rates were as high as 27.7% in these PM/DM patients. Higher mean daily doses of steroids, lymphopenia, and lower serum total protein levels were significantly more frequent in the group of PM/DM patients with opportunistic infections. Conclusion. Our study underscores the high frequency of opportunistic infections in PM/DM, resulting in an increased mortality rate. It also indicates that a great variety of microorganisms are responsible for opportunistic infections, although they were more often due to fungi (>50% of cases). Our series highlights a predominance of both lung and digestive opportunistic infections (89% of cases). In addition, our results suggest that PM/DM patients presenting with factors predictive of opportunistic infection may require closer monitoring.

Invasive Fungal Infection as the Initial Presentation of Systemic Lupus Erythematosus

“…Early and accurate diagnosis plays an important role in the management of IPFI [5]. Without timely therapeutic interventions, the mortality rate has reached 30-80% [12], and many cases were only diagnosed post-mortem [2,13]. For patients with risk factors for IPFI, an empirical anti-fungal therapy may provide a prognostic benefit.…”

Musculoskeletal Tuberculosis in Dermatomyositis: Association or Coincidence?

“…At this time, she was taking azathioprine 3 mg/kg/day, methotrexate 25 mg/ week and prednisone 12.5 mg/day, when she developed progressive swelling and pain in hands and wrists (Figure 1(A)) for two months, with no other symptoms. Laboratory tests showed C-reactive protein 3.1 mg/L, erythrocyte sedimentation rate 5 mm/1st hour, leukocytosis up to 9070 cells/mm 3 . Hands ultrasonography showed flexor tendons tenosynovitis, involving the carpus and the forearms, fluid collection in the left forearm and subcutaneous edema positive doppler.…”

“…Six months ago, the disease was under control using methotrexate 25 mg/week, cyclosporine 2 mg/kg/day and prednisone 5 mg/day, when he presented pain and swelling in hands and forearms. Laboratory tests showed C-reactive protein 29.8 mg/L, erythrocyte sedimentation rate 16 mm/1st hour, leukocytosis up to 9140 cells/mm 3 . Hands ultrasonography showed flexor tendons tenosynovitis, involving the carpus and the forearms, edema of the subcutaneous tissue positive doppler (Figures 2(A) and (B)).…”

“…Opportunistic infections occur in 6.3% to 21.3% of dermatomyositis/polymyositis patients [3][4][5][6][7]. This high prevalence in part is due to the chronic use of corticosteroids and/or immunosuppressives to control the disease.…”

Nodular Amyloidosis Overlapping and Polymyositis in a Patient with Skin Manifestations Lupus Fax: Case Report

“…It is believed that this process is triggered by external factors in genetically predisposed people. These pathologies may occur alone, or associated with malignancy or other connective tissue autoimmune diseases, such as systemic lupus erythematosus, Sjögren's syndrome, and others [5] [6]. Polymyositis is characterized by progressive and symmetrical proximal muscular weakness, in which dysphagia is observed in most patients.…”