Polymyositis associated with ulcerative colitis.

Abstract

An elderly woman with chronic ulcerative colitis who developed proximal muscle weakness, increased serum creatine phosphokinase activity, and histological and electromyographic abnormalities characteristic of polymyositis is described. Treatment with corticosteroids and 5-acetylsalicylic acid was followed by a remission in bowel symptoms, improvement in muscle power, and reversal of electromyographic changes. An autoimmune link between the two disorders seems likely. (Gut 1993; 34: 567-569) Case report A 78 year old woman was admitted to hospital for investigation and management of diarrhoea and muscle weakness. She had been having recurrent episodes of diarrhoea associated with the passage of blood and mucus, low grade fever, and a feeling of exhaustion for the past 15 years. Each episode lasted for 7 to 10 days, followed by a symptom free period of 2-3 months. She had never visited hospital and was treated symptomatically by general practitioners with antidiarrhoeal drugs. During the past 15 days, she had started having arthralgias that affected multiple joints and appreciable proximal muscle weakness of both lower and upper limbs. The patient was prescribed indomethacin (25 mg thrice daily) for arthralgia by her treating physician. She had lost about 4 kg of weight over the previous 2 weeks.Physical examination at the time of hospital admission showed moderate pallor and mild dehydration. The patient's pulse rate was 96 bpm and the volume was slightly decreased. Her blood pressure was 100/60 mm Hg. The small joints of the hands were tender to pressure and movement. Abdominal examination showed mild tenderness in the hypogastrium, and the patient's spleen was palpable 2 cm below the left costal margin and was firm in consistency. Neurological examination showed weakness of the proximal muscles of the lower and upper Laboratory investigations showed a haemoglobin concentration of 78 g/l and a haematocrit of 23%. The patient's total leukocyte count was 8600/mm3 (8-6x 109/l), with neutrophils 85%, lymphocytes 13%, and eosinophils 2%. The erythrocyte sedimentation rate was 67 mm in the first hour (Westergren) and reticulocyte count 5%. A coagulogram was normal. Platelets were 110000/mm3 (110x109/l). Serum Na was 135 mmol/l and K 3-3 mmol/l. Blood urea was 28 mg/dl (9 9 mmol/l) and serum creatinine 1-0 mg/dl (88-4 mmol/l). Serum bilirubin was 0-8 mg/dl (13-6 mmol/l); SGOT was 13 U/1, SGPT was 7 U/l and alkaline phosphatase was 10 KAU. The total serum protein was 74 g/l with an albumin concentration of 36 g/l, globulin 38 g/l, and an albumin/globulin ratio of 0 95. The patient's urine was negative for protein and sugar, and microscopy showed 10-12 pus cells/ high power field. Urine culture showed growth of Pseudomonas aeruginosa. Stools showed the presence of red cells (+++++) but no ova or cysts, and culture grew Candida albicans. Upper gastrointestinal endoscopy showed features of oesophagitis and erosive gastritis. A barium enema showed extensive ulceration in the entire large bowel (Figs 1 and 2) and...

Severe skeletal muscle damage following the administration of mesalazine to a patient with ulcerative colitis

“…2 Skeletal muscle involvement associated with inflammatory bowel disease is an extremely rare extra-intestinal manifestation. 3,4 In these instances, skeletal muscle damage associated with 5-ASA treatment has not been reported.…”

“…Non‐traumatic muscle damage can be induced by various mechanisms such as infection, excessive alcohol intake, and exposure to certain drugs 2 . Skeletal muscle involvement associated with inflammatory bowel disease is an extremely rare extra‐intestinal manifestation 3,4 . In these instances, skeletal muscle damage associated with 5‐ASA treatment has not been reported.…”

Review article: the gastrointestinal complications of myositis

“…Polymyositis and DM can be rare extraintestinal manifestations of Crohn’s disease or ulcerative colitis (UC) 12–15 . Patients with myositis and Crohn’s disease usually have colonic involvement 15 .…”

Rare Extraintestinal Manifestations of Inflammatory Bowel Disease

“…71 Other isolated cases of inflammatory and granulomatous myopathies support this notion. [77][78][79][80][81][82]…”