Systemic lupus erythematosus and dermatomyositis: Case report

Abstract

The association of systemic lupus erythematosus (SLE) with idiopathic polymyositis or dermatomyositis is reported to occur in the range of 4-16%. Myositis can occur before or after SLE, or sporadically both diseases can be present simultaneously. This case report concerns a 36-year-old female patient suffering from Raynaud's phenomenon, polyarthralgia in the small joints of the hands, and skin changes compatible with Gotron's indications. Symmetric proximal muscle weakness of the extremities, fever of up to 40 degrees C, heliotrope rashes with erythematous changes in the face, upper arms, and posterior shoulders occurred subsequently. Laboratory analyses revealed increased acute phase reactants, hypochromic anaemia, lymphopenia, and increased levels of all muscle enzymes. Immunoserology demonstrated positive ANA, anti-Sm, and anticardiolipin antibodies (aCL), while anti dsDNA, anti Ro, anti La, and anti Jo-1 antibodies proved negative. Hypocomplementaemia and elevated levels of immune complexes were also detected. Pathologic sediment and proteinuria were revealed via urine analyses, while a kidney biopsy confirmed lupus nephritis (type IVa according to the World Health Organisation classification). Biopsy of erythematous changes of the posterior shoulder demonstrated leukocytoclastic vasculitis. Electromyography of the lower extremities established myopathic changes. Inflammation of the muscles was confirmed via magnetic resonance imaging. The patient was categorised as having two separate coexistent diseases--SLE and dermatomyositis. Both the classification criteria of the American College of Rheumatology for SLE and the diagnostic criteria for dermatomyositis, proposed by Bohon and Peter, were fulfilled simultaneously. Treatment commenced with pulses of methylprednisolone and continued with oral therapy, including Resochin. Pulses of intravenous cyclophosphamide were also administered. After six weeks of therapy, biohumoral remission of both diseases was achieved, while complete recovery from muscle weakness was accomplished after four months.

Systemic Lupus Erythematosusmyositis Overlap Syndrome: Report of 6 Cases

“…4,14,17,18 Our lupus myositis patients were all female which is concordant to the previous studies. 3,7,14,17,19 The study reported by Foot et al 6 suggested that lupus myositis was very similar to primary disease, in contrast to the milder descriptions of Fessel 16 and Tsokos et al 5 were less than rigorous: all but one of their patients with alleged myositis had a normal serum CK, and only 5/18 subjects had a confirmatory muscle biopsy. Although it remains unclear, some reports have indicated that this overlap syndrome follows a benign course and that the prognosis of myositis associated with SLE is reputed to be better than primary myositis in terms of morbidity and response to therapy.…”

“…In the literature, SLE associated with myositis occurs in 4–16% of cases. 14 In contrast to myalgia which can affect nearly half of patients with SLE, true myositis is relatively rare as shown also by our study. 15 Myositis can occur before, after SLE (case 2), or sporadically both diseases can be present simultaneously (cases 1, 3, 4, 5 and 6 in our series).…”

“…15 Myositis can occur before, after SLE (case 2), or sporadically both diseases can be present simultaneously (cases 1, 3, 4, 5 and 6 in our series). 14 …”

Electrophysiological and Clinical Examination of Polymyositis: A Retrospective Analysis

“…Case reports have described PM or IIM being associated with systemic lupus erythematosus, 10 scleroderma, 11 Sjögren's syndrome 12 and myasthenia. PM-associated death is often due to lung fibrosis and severe infection.…”

Primary Cutaneous B-Cell Lymphoma, Leg Type Restricted to the Subcutaneous Fat Arising in a Patient With Dermatomyositis

“…Lupus erythematosus has been reported to occur in association with DM in the range of 4%-16%. 21 Furthermore, cases of subcutaneous panniculitis-like lymphoma arising in patients with lupus panniculitis/lupus erythematosus have been described. However, these have universally been described as T-cell processes not limited to the subcutis.…”