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one case of dermatomyositis complicated by pericarditis

from:e.uuuwell.com  2017-4-21 19:30

   

one case of dermatomyositis complicated by pericarditis

journal of dermatology 1998, volume 31 issue 1 case report

author: chen li yu baotian

units: 100 730 beijing, china chinese academy of medical sciences peking union medical college beijing union medical college hospital dermatology [zhen li (training physicians, now shanxi medical university first clinical medical college of dermatology) yu baotian]

female patient, 41 years old. due to the face, hands and back limbs erythema associated with myalgia, muscle weakness, intermittent fever and joint pain 4 months in hospital in december 1986. admission examination: lung liver and spleen were normal. dermatology seen: face and upper eyelid with a dark red rash and papules, gottron sign was positive. limb muscle strength grade Ⅱ, left and right hand grip strength were 13 and 16kg, muscle tenderness positive. laboratory tests: urine normal routine. ast 1434nmol · s-1 · l-1 (normal <500 · s-1 · l-1), creatine kinase 15 243nmol · s-1 · l-1 (normal <1960nmol · s-1 · l-1) , lactate dehydrogenase 5.4μmol · s-1 · l-1 (normal <1.5μmol · s-1 · l-1), ana1: 40 positive, rheumatoid factor positive, esr 70mm/1h. icon emg muscle-derived damage (active), muscle biopsy not done. diagnosed with dermatomyositis. given prednisone 40mg / d, 2 months plus cyclophosphamide 0.2g, every other day, intravenous injection. total 8g. condition improved, prednisone 20mg / d discharged. maintenance therapy for 2 years. subsequently, prednisone was reduced to 15mg / d, with monthly cyclophosphamide 800mg, intravenous injection of 8 times. change after the oral administration of 50mg / d, a total of four months. stable condition. september 1989 prednisone 10mg / d, cyclophosphamide disabled 1 month later, the patient palpitations, shortness of breath. physical examination: heart rate 107 times, law qi, expand the left heart border. ecg showed sinus tachycardia, b-confirmed a small amount of pericardial effusion. x-ray showed a flask-like changes in the heart. muscle still, myalgia obvious, normal serum muscle enzymes. prednisone to 40mg / d, cyclophosphamide 0.2g, every other day, intravenous injection; 3 weeks after symptoms disappear. after four years in the amount of prednisone 30mg ~ 60mg / d between the gap with cyclophosphamide were 9.8g. although from time to time, or decreased muscle strength, muscle enzymes, but the b-no pericardial effusion. in june 1993, prednisone was reduced to 15mg / d, out 2 months of cyclophosphamide, the patient has palpitations, shortness of breath, chest tightness. physical examination: heart rate 110 times, the end of smell of wet lung