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Recurrence of anti-MDA5 antibody-positive clinically amyopathic dermatomyositis after long-term remission: A case report.
- Source :
-
Medicine [Medicine (Baltimore)] 2018 Jun; Vol. 97 (26), pp. e11024. - Publication Year :
- 2018
-
Abstract
- Rationale: Among all dermatomyositis (DM) patients, antimelanoma differentiation-associated gene 5 antibody (anti-MDA5 Ab) positive patients have significantly poor short-term mortality, whereas they experience less relapses over the long term after the remission. We report the case of a patient with anti-MDA5 Ab-positive clinically amyopathic dermatomyositis (CADM) with the recurrence of interstitial lung disease (ILD) after 7 years of remission. There has been no case report of an anti-MDA5 Ab-positive DM patient with the recurrence of ILD after 7 years of long-term remission.<br />Patient Concerns: A 70-year-old Japanese woman was diagnosed with anti-MDA5 Ab-positive CADM and ILD. After achieving 7 years long-term remission, she was admitted to our department with erythema on the fingers and interstitial pneumonia. Her anti-MDA5 Ab titer was elevated.<br />Diagnoses: We diagnosed recurrent CADM complicated with ILD.<br />Interventions: We successfully treated her with 1,000 mg of methyl-prednisolone pulse and intravenous cyclophosphamide therapy followed by prednisolone 50 mg/day and an increase of cyclosporine.<br />Outcomes: After that treatment, the patient's skin symptoms and interstitial pneumonia were relieved. All laboratory investigations such as ferritin, the serum markers of interstitial pneumonia (i.e., SP-A, SP-D), and the titer of anti-MDA5 Ab showed signs of improvement.<br />Lessons: Her case suggests that careful physical examinations and monitoring the serum markers are important even after long-term remission is achieved.
- Subjects :
- Administration, Intravenous
Aged
Anti-Inflammatory Agents therapeutic use
Asian People ethnology
Biomarkers blood
Cyclophosphamide administration & dosage
Cyclophosphamide therapeutic use
Cyclosporine administration & dosage
Cyclosporine therapeutic use
Dermatomyositis complications
Dermatomyositis diagnosis
Dermatomyositis drug therapy
Female
Ferritins blood
Ferritins drug effects
Humans
Immunosuppressive Agents therapeutic use
Interferon-Induced Helicase, IFIH1 immunology
Lung Diseases, Interstitial diagnostic imaging
Lung Diseases, Interstitial drug therapy
Lung Diseases, Interstitial immunology
Methylprednisolone administration & dosage
Methylprednisolone therapeutic use
Recurrence
Tomography, X-Ray Computed
Treatment Outcome
Autoantibodies blood
Dermatomyositis immunology
Interferon-Induced Helicase, IFIH1 antagonists & inhibitors
Lung Diseases, Interstitial complications
Subjects
Details
- Language :
- English
- ISSN :
- 1536-5964
- Volume :
- 97
- Issue :
- 26
- Database :
- MEDLINE
- Journal :
- Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 29952940
- Full Text :
- https://doi.org/10.1097/MD.0000000000011024