BibTex RIS Cite

Severe Respiratory Failure in the Coexistence of Polymyositis and Hypothyroidism: A Case Report

Year 2013, Volume: 38 Issue: 4, 744 - 750, 01.12.2013

Abstract

Polymyositis is a systemic, inflammatory muscle disease. Respiratory insufficiency as a result of respiratory muscle involvement could also be observed. Here we report a fortyone-year-old man who attended to the hospital with the complaints of shortness of breath and chest pain that have suddenly started. Physical examination has revealed proximal muscle weakness. Serum creatinine phosphokinase level has increased, ANA was positive and the electromyographic examination has revealed myopathic changes. Deltoid muscle biopsy was in accordance with polymyositis. Methyl-prednisolone 1 gram iv pulse therapy was given during the first 5 days. He was started with 25 mg/week parenteral methotrexate. Laboratory tests suggested hypothyroidism and levothyroxine replacement therapy was started. The clinical findings have improved concomitant with the reduction in the muscle enzymes and thyroid stimulant hormone levels into the normal ranges. He was discharged with the recommendation of the NIMV device application during night-time. The clinical symptoms are more severe in the presence of alveolar hypoventilation due to polymyositis and coincidantal hypothyroidism.

References

  • Maclean J, Singh RB, Sayeed ZA. Polymyositis presenting with respiratory failure. Indian J Chest Dis Allied Sci. 2011; 53:229-31
  • Tymms KE, Webb J. Dermatopolymyositis and other connective tissue diseases: a review of 105 cases. J Rheumatol. 1985; 12:1140-8.
  • Fathi M, Lundberg IE, Tornling G. Pulmonary complications of polymyositis and dermatomyositis. Semin Respir Crit Care Med. 2007; 28:451-8.
  • Hochberg MC, Koppes GM, Edwards CQ, Barnes HV, Arnett FC Jr. Hypothyroidism presenting as a polymyositis-like syndrome. Report of two cases. Arthritis Rheum. 1976; 19:1363-6.
  • Madariaga M. Polymyositis-Like syndrome in hypothyroidism: review of cases reported over the past twenty-five tears.Thyroid. 2002; 12:331-36,
  • Gülbün Yüksel, Ayşe Alpınar, Nuriye Çömez, Cihat Örken, Hülya Tireli. Hypothyroidism Presenting as a Polymyositis-Like Syndrome (Case Report). Journal of Neurological Sciences. 2007;24:244-249
  • Bohan A, Peter JB. Polymyositis and dermatomyositis (parts 1 and 2). N Engl J Med. 1975; 292:344–7.
  • Denbow CE, Lie JT, Tancredi RG, Bunch TW. Cardiac involvement in polymyositis:a clinicopathologic study of 20 autopsied patients. Arthritis Rheum. 1979; 22:1088-92.
  • Larca LJ, Coppola JT, Honig S. Creatine kinase MB isoenzyme in dermatomyositis: a noncardiac source. Ann Intern Med. 1981; 94:341-3.
  • Badsha H, Gunes B, Grossman J, Brahn E.Troponin I Assessment of Cardiac Involvement in Patients With Connective Tissue Disease and an Elevated Creatine Kinase MB Isoform Report of Four Cases and Review of the Literature. J Clin Rheumatol. 1997; 3:131Ingegnoli F, Lubatti C, Ingegnoli A, Boracchi P, Zeni
  • S, Meroni PL. Interstitial lung disease outcomes by high-resolution computed tomography (HRCT) in Anti-Jo1 antibody-positive polymyositis patients: a single centre study andreview of the literature. Autoimmun Rev. 2012; 11:335-40.
  • Bohan A, Peter JB, Bowman RL, Pearson CM. Computer-assisted analysis of 153 patients with polymyositis and dermatomyositis. Medicine (Baltimore). 1977; 56:255-86.
  • Sbrocchi AM, Chédeville G, Scuccimarri R, Duffy CM, Krishnamoorthy P. Pediatric hypothyroidism presenting with a polymyositis-like syndrome and increased creatinine: report of three cases. J Pediatr Endocrinol Metab. 2008; 21:89-92.
  • Amato A.A.: Endocrin Myopathies and Toxic Myopathies. Ed: Brown W.F, Bolton C.F, Aminof M.J, Neuromuscular Function and Disease. Basic, Clinical and Electrodiagnostic Aspects. Vol 2,78:1399-1402, Saunders Company, Philadelphia. 2002.
  • Gurubhagavatula I, Palevsky HI. Pulmonary hypertension in systemic autoimmun diseases. Clin Exp Rheumotol. 1991; 9:137-141.
  • Lateiwish AM, Fehér J, Baraczka K, Rácz K, Kiss R, Gláz E. Remission of Raynaud's phenomenon after L-thyroxine therapy in a patient with hypothyroidism. J Endocrinol Invest. 1992; 15:49-51.
  • Chu JW, Kao PN, Faul JL, Doyle RL. High prevalence of autoimmune thyroid disease in pulmonary arterial hypertension. Chest. 2002; 122:1668-73.
  • Sekiguchi K, Kanda F, Oishi K, Hamaguchi H, Nakazawa K, Maeda N et al. HLA typing in focal myositis. J Neurol Sci. 2004; 227:21-5.
  • Hohlfeld R, Engel AG. The immunobiology of muscle. Immunol Today. 1994; 15:269-74.
  • Dickey BF, Myers AR. Pulmonary disease in polymyositis/dermetomyositis. Semin Arthritis Rheum. 1984; 14:60-76.
  • Braun NMİ, Arora NS, Rochester DF. Respiratory muscle and pulmonary function in polymyositis and other proximal myopathies. Thorax. 1983; 38:616-23.
  • Martin L, Chalmers IM, Dhingra S, McArthy D, Hunter D. Measurements of maximum respiratory pressures in polymyositis and dermatomyositis. J Rheum. 1985; 12:104-7. Annane D, Quera
  • ‐Salva MA, Lofaso F, Vercken JB, Lesieur O, Fromageot C et al. Mechanisms underlying effects of nocturnal ventilation on daytime blood gases in neuromuscular diseases. Eur Respir J. 1999;13:157–62.
  • Yazışma Adresi / Address for Correspondence: Dr. Fatih Yıldız, Cukurova University Faculty of Medicine, Department of Rheumatology-Immunology Balcalı Hospital, Sarıçam, 01330 ADANA
  • E mail: drfatih75@gmail.com geliş tarihi/received :12.02.2013 kabul tarihi/accepted:01.04.2013

Şiddetli solunum yetmezliğine neden olan polimiyozit ve hipotiroidi birlikteliği : Olgu sunumu

Year 2013, Volume: 38 Issue: 4, 744 - 750, 01.12.2013

Abstract

Polimyozit sistemik inflamatuar bir kas hastalığıdır. Solunum kas tutulumuna bağlı solunum yetmezliği görülebilen bir klinik tablodur. Burada 41 yaşında hastanemize ani başlayan nefes darlığı ve göğüs ağrısı şikayetleriyle başvuran bir hasta sunulmuştur. Muayenesinde proksimal kas güçsüzlüğü saptandı. Kreatin fosfokinaz yüksekliği, ANA pozitifliği ve elektromyografik incelemesinde myopatik değişiklikler bulundu. Deltoid kas biyopsisi sonucu polimyozit ile uyumlu bulundu. Hastaya 5 gün 1 gram iv pulse metil prednizolon tedavisi uygulandı. Aynı zamanda 25 mg/hafta parenteral metotreksat tedavisi uygulandı. Laboratuar testinde hipotiroidi de tespit edilmesi üzerine levotiroksin replasmanı tedaviye eklendi. Takipte klinik bulgular ile birlikte kas enzimleri ve tiroid stimülan hormon düzeyleri düzelen hasta gece NIMV kullanımı önerisi ile taburcu edildi. Polimyozite hipotiroidinin eşlik ettiği tabloda klinik semptomlar daha ciddi izlenmektedir.

References

  • Maclean J, Singh RB, Sayeed ZA. Polymyositis presenting with respiratory failure. Indian J Chest Dis Allied Sci. 2011; 53:229-31
  • Tymms KE, Webb J. Dermatopolymyositis and other connective tissue diseases: a review of 105 cases. J Rheumatol. 1985; 12:1140-8.
  • Fathi M, Lundberg IE, Tornling G. Pulmonary complications of polymyositis and dermatomyositis. Semin Respir Crit Care Med. 2007; 28:451-8.
  • Hochberg MC, Koppes GM, Edwards CQ, Barnes HV, Arnett FC Jr. Hypothyroidism presenting as a polymyositis-like syndrome. Report of two cases. Arthritis Rheum. 1976; 19:1363-6.
  • Madariaga M. Polymyositis-Like syndrome in hypothyroidism: review of cases reported over the past twenty-five tears.Thyroid. 2002; 12:331-36,
  • Gülbün Yüksel, Ayşe Alpınar, Nuriye Çömez, Cihat Örken, Hülya Tireli. Hypothyroidism Presenting as a Polymyositis-Like Syndrome (Case Report). Journal of Neurological Sciences. 2007;24:244-249
  • Bohan A, Peter JB. Polymyositis and dermatomyositis (parts 1 and 2). N Engl J Med. 1975; 292:344–7.
  • Denbow CE, Lie JT, Tancredi RG, Bunch TW. Cardiac involvement in polymyositis:a clinicopathologic study of 20 autopsied patients. Arthritis Rheum. 1979; 22:1088-92.
  • Larca LJ, Coppola JT, Honig S. Creatine kinase MB isoenzyme in dermatomyositis: a noncardiac source. Ann Intern Med. 1981; 94:341-3.
  • Badsha H, Gunes B, Grossman J, Brahn E.Troponin I Assessment of Cardiac Involvement in Patients With Connective Tissue Disease and an Elevated Creatine Kinase MB Isoform Report of Four Cases and Review of the Literature. J Clin Rheumatol. 1997; 3:131Ingegnoli F, Lubatti C, Ingegnoli A, Boracchi P, Zeni
  • S, Meroni PL. Interstitial lung disease outcomes by high-resolution computed tomography (HRCT) in Anti-Jo1 antibody-positive polymyositis patients: a single centre study andreview of the literature. Autoimmun Rev. 2012; 11:335-40.
  • Bohan A, Peter JB, Bowman RL, Pearson CM. Computer-assisted analysis of 153 patients with polymyositis and dermatomyositis. Medicine (Baltimore). 1977; 56:255-86.
  • Sbrocchi AM, Chédeville G, Scuccimarri R, Duffy CM, Krishnamoorthy P. Pediatric hypothyroidism presenting with a polymyositis-like syndrome and increased creatinine: report of three cases. J Pediatr Endocrinol Metab. 2008; 21:89-92.
  • Amato A.A.: Endocrin Myopathies and Toxic Myopathies. Ed: Brown W.F, Bolton C.F, Aminof M.J, Neuromuscular Function and Disease. Basic, Clinical and Electrodiagnostic Aspects. Vol 2,78:1399-1402, Saunders Company, Philadelphia. 2002.
  • Gurubhagavatula I, Palevsky HI. Pulmonary hypertension in systemic autoimmun diseases. Clin Exp Rheumotol. 1991; 9:137-141.
  • Lateiwish AM, Fehér J, Baraczka K, Rácz K, Kiss R, Gláz E. Remission of Raynaud's phenomenon after L-thyroxine therapy in a patient with hypothyroidism. J Endocrinol Invest. 1992; 15:49-51.
  • Chu JW, Kao PN, Faul JL, Doyle RL. High prevalence of autoimmune thyroid disease in pulmonary arterial hypertension. Chest. 2002; 122:1668-73.
  • Sekiguchi K, Kanda F, Oishi K, Hamaguchi H, Nakazawa K, Maeda N et al. HLA typing in focal myositis. J Neurol Sci. 2004; 227:21-5.
  • Hohlfeld R, Engel AG. The immunobiology of muscle. Immunol Today. 1994; 15:269-74.
  • Dickey BF, Myers AR. Pulmonary disease in polymyositis/dermetomyositis. Semin Arthritis Rheum. 1984; 14:60-76.
  • Braun NMİ, Arora NS, Rochester DF. Respiratory muscle and pulmonary function in polymyositis and other proximal myopathies. Thorax. 1983; 38:616-23.
  • Martin L, Chalmers IM, Dhingra S, McArthy D, Hunter D. Measurements of maximum respiratory pressures in polymyositis and dermatomyositis. J Rheum. 1985; 12:104-7. Annane D, Quera
  • ‐Salva MA, Lofaso F, Vercken JB, Lesieur O, Fromageot C et al. Mechanisms underlying effects of nocturnal ventilation on daytime blood gases in neuromuscular diseases. Eur Respir J. 1999;13:157–62.
  • Yazışma Adresi / Address for Correspondence: Dr. Fatih Yıldız, Cukurova University Faculty of Medicine, Department of Rheumatology-Immunology Balcalı Hospital, Sarıçam, 01330 ADANA
  • E mail: drfatih75@gmail.com geliş tarihi/received :12.02.2013 kabul tarihi/accepted:01.04.2013
There are 25 citations in total.

Details

Primary Language Turkish
Journal Section Research
Authors

Fatih Yıldız

Didem Arslan Taş This is me

Ezgi Özyılmaz This is me

Mehtap Evran This is me

Emre Karakoç This is me

Suzan Zorludemir This is me

Eren Erken This is me

Publication Date December 1, 2013
Published in Issue Year 2013 Volume: 38 Issue: 4

Cite

MLA Yıldız, Fatih et al. “Şiddetli Solunum yetmezliğine Neden Olan Polimiyozit Ve Hipotiroidi birlikteliği : Olgu Sunumu”. Cukurova Medical Journal, vol. 38, no. 4, 2013, pp. 744-50.