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1.
《Modern rheumatology / the Japan Rheumatism Association》2013,23(4):397-402
AbstractWe report a polymyositis patient who developed Candida pneumonia, whose clinical manifestations such as dry cough, dyspnea, fever and elevated LDH looked like a recurrence of interstitial pneumonitis (IP) which she had had at admission. The distribution of the lesions in high resolution computed tomography scan, the high serum level of β-d-glucan and positive Candida antigen test led to make a diagnosis of Candida pneumonia rather than IP, and fluconazole therapy was successful. 相似文献
2.
Yasuhide Takano Koichi Amano Kazutoshi Aoki Tsutomu Takeuchi 《Modern rheumatology / the Japan Rheumatism Association》1999,9(4):397-402
We report a polymyositis patient who developedCandida pneumonia, whose clinical manifestations such as dry cough, dyspnea, fever and elevated LDH looked like a recurrence of interstitial
pneumonitis (IP) which she had had at admission. The distribution of the lesions in high resolution computed tomography scan,
the high serum level of β-d-glucan and positiveCandida antigen test led to make a diagnosis ofCandida pneumonia rather than IP, and fluconazole therapy was successful. 相似文献
3.
Kenji?Nagasaka Masayoshi?Harigai Mutsuto?Tateishi Masako?Hara Yasuyuki?Yoshizawa Takao?Koike Nobuyuki?Miyasaka
Interstitial pneumonitis (IP) associated with polymyositis and dermatomyositis (PM/DM) is a serious complication that affects prognosis. We therefore undertook a retrospective multicenter study to examine the efficacy of a combination treatment with cyclosporin A (CsA) and corticosteroids. Fifty-three IP patients with PM/DM (9 PM, 44 DM) were analyzed. Thirty-two patients treated with CsA plus corticosteroids (9 PM, 23 DM) were included in the study. Four parameters, i.e., subjective symptoms, ausculatory sound, chest radiographs, and respiratory index, were serially evaluated. A general evaluation was performed 4 weeks after the start of the combination treatment. All patients with PM and chronic IP with DM, and 52% of those with acute IP with DM were graded as better than partially effective in the general evaluation. In contrast, all patients graded as progressive in the general evaluation had acute IP with DM. It is of note that in acute IP with DM, the survival rate of the group primarily treated with CsA and corticosteroids from the early stage of their disease was significantly higher than that of the group initially treated with corticosteroids alone (P = 0.049). In conclusion, a combination treatment of CsA and corticosteroids from the early stage of disease may be advantageous for patients with IP with PM/DM, especially acute IP with DM. 相似文献
4.
《Modern rheumatology / the Japan Rheumatism Association》2013,23(3):231-238
AbstractInterstitial pneumonitis (IP) associated with polymyositis and dermatomyositis (PM/DM) is a serious complication that affects prognosis. We therefore undertook a retrospective multicenter study to examine the efficacy of a combination treatment with cyclosporin A (CsA) and corticosteroids. Fifty-three IP patients with PM/DM (9 PM, 44 DM) were analyzed. Thirty-two patients treated with CsA plus corticosteroids (9 PM, 23 DM) were included in the study. Four parameters, i.e., subjective symptoms, ausculatory sound, chest radiographs, and respiratory index, were serially evaluated. A general evaluation was performed 4 weeks after the start of the combination treatment. All patients with PM and chronic IP with DM, and 52% of those with acute IP with DM were graded as better than “partially effective” in the general evaluation. In contrast, all patients graded as “progressive” in the general evaluation had acute IP with DM. It is of note that in acute IP with DM, the survival rate of the group primarily treated with CsA and corticosteroids from the early stage of their disease was significantly higher than that of the group initially treated with corticosteroids alone (P = 0.049). In conclusion, a combination treatment of CsA and corticosteroids from the early stage of disease may be advantageous for patients with IP with PM/DM, especially acute IP with DM. 相似文献
5.
Y. Tokano H. Ogasawara S. Ando T. Fujii H. Kaneko N. Tamura T. Yano K. Hirokawa T. Fukazawa A. Murashima S. Kobayashi I. Sekigawa Y. Takasaki N. Iida H. Hashimoto 《Modern rheumatology / the Japan Rheumatism Association》2002,12(4):0305-0310
To determine the efficacy of cyclosporin A (CysA) for the treatment of steroid-resistant interstitial pneumonitis (IP), we enrolled 25 patients with various rheumatic diseases and steroid-resistant IP in a pilot study [4 patients with rheumatoid arthritis (RA), 2 with systemic lupus erythematosus (SLE), 11 with polymyositis/dermatomyositis (PM/DM), 4 with systemic sclerosis (SSc), 1 with mixed connective tissue disease (MCTD), 3 with Sjögren syndrome (SS)]. Twelve patients (48%) showed a persistent response to CysA therapy, and 7 of them had PM/DM, including so-called amyopathic DM. Patients with a persistent response had moderately elevated lactate dehydroxygenase (LDH) levels, whereas patients who died had much higher LDH levels and hypoxia. Even patients with low blood levels of CysA achieved a persistent response. In responding patients, the symptoms, chest X-ray findings, arterial oxygen tension, and LDH level all improved after less than 4 weeks. In conclusion, CysA seem to be useful for treating patients with steroid-resistant IP, whose duration is short and severity is mild. 相似文献
6.
A case of dermatomyositis complicated with pneumomediastinum successfully treated with cyclosporin A
Kuroda T Morikawa H Satou T Tanabe Y Murakami S Ito S Nakan M Gejyo F 《Clinical rheumatology》2003,22(1):45-48
We describe a rare case of a 46-year-old Japanese man with dermatomyositis (DM) and interstitial lung disease who developed
spontaneous pneumomediastinum and subcutaneous emphysema. Relatively mild myositis, mild elevation of CK values and the absence
of anti-Jo-1 antibody were observed and the case was similar to amyopathic DM. Treatment of this patient with oral prednisolone
and cyclosporin A (CsA) was effective for the myositis and interstitial lung disease. The administration of CsA enabled rapid
tapering of the dose of prednisolone without aggravating the disease. Pneumomediastinum and subcutaneous emphysema disappeared
5 months later without recurrence. The serum levels of KL-6 were monitored every 2 weeks to help determine whether this may
have contributed to the recurrence of interstitial pneumonitis. This is a rare case of pneumomediastinum in a patient with
DM.
Received: 6 May 2002 / Accepted: 26 August 2002 相似文献
7.
H. Ogasawara MD M. Sekiya A. Murashima T. Hishikawa Y. Tokano N. Sekigawa N. Iida H. Hashimoto S. Hirose 《Clinical rheumatology》1998,17(2):160-162
Cyclosporin is known to be effective for both transplantation and a spectrum of immune-mediated diseases. Because this agent also causes severe adverse effects, especially nephrotoxicity, careful monitoring is required for the development of such reactions. Here we report the successful treatment with extremely low-dose cyclosporin (1 mg/kg/day) of a patient who had steroidresistant interstitial pneumonitis and Sjögren's syndrome. 相似文献
8.
Takada K Kishi J Miyasaka N 《Modern rheumatology / the Japan Rheumatism Association》2007,17(2):123-130
Corticosteroids (CS) are the standard initial treatment for interstitial pneumonia (IP) associated with dermatomyositis (DM)/polymyositis
(PM). However, many patients fail to respond and have significantly high mortality even if immunosuppressive drugs (ISDs)
are subsequently added, while a more intensive initial approach using ISDs is suggested to improve their survival. We conducted
a retrospective study to examine the association between initial therapeutic approaches and clinical outcomes of active IP
in DM/PM patients. We reviewed medical records of 34 consecutive DM/PM patients who had active IP defined by the presence
of pulmonary function abnormality or active symptoms, and compared clinical outcome between those patients to whom ISDs were
added if CS alone did not result in a favorable response (a step-up approach) and those who were started on ISDs simultaneously
with CS (a primary intensive approach). Clinical endpoints were death, pulmonary death, and progression or improvement of
pulmonary function. The step-up approach was used in 20 patients, to 11 of whom ISDs were eventually added after a median
of 2.0 weeks, while the primary intensive approach was used in 14 patients. The primary intensive approach group had significantly
better survival than the step-up approach group (P = 0.030 by the log-rank test). These two groups did not differ significantly in demographic characteristics and baseline
clinical and laboratory features. Intensive approach by starting ISDs simultaneously with CS in the initial treatment for
active IP in DM/PM patients was associated with better survival, emphasizing the impact of initial treatment on their survival.
Prospective clinical investigation of this approach is now needed, but the limited clinical utility of CS as an initial treatment
might ethically challenge clinical-trial designing. 相似文献
9.
Terao M Ozawa K Inui S Murota H Yokomi A Itami S 《Modern rheumatology / the Japan Rheumatism Association》2007,17(2):156-159
We herein describe a 16-year-old boy with pneumomediastinum, pneumothorax, and subcutaneous emphysema as the initial symptoms
of dermatomyositis (DM). His pneumomediastinum disappeared after strict bed rest and he was thereafter successfully treated
with oral prednisolone and cyclosporine A. His condition was further complicated with mild interstitial lung disease, arrhythmia,
and skin ulcers on his fingertips, right elbow, ear, and sacral region. Pneumomediastinum is a rare complication of DM and
its pathogenesis remains unclear. We review the literature and discuss the possible mechanism of this disease. 相似文献
10.
Nagy F Molnar T Makula E Kiss I Milassin P Zollei E Tiszlavicz L Lonovics J 《World journal of gastroenterology : WJG》2007,13(2):316-319
The early hypersensitivity reaction and late bone marrow depression are well-known side-effects of azathioprine, whereas interstitial pneumonia is a rare complication. A 40-year old male patient had been treated with azathioprine in consequence of extensive ulcerative colitis for 10 years. He then complained of 7 d of fever, cough and catarrhal signs, without symptoms of active colitis. Opportunistic infections were ruled out. The chest X-ray, CT and lung biopsy demonstrated the presence of interstitial inflammation. Azathioprine therapy was discontinued as a potential source of the pulmonary infiltrate. In response to steroid therapy, and intensive care, the pulmonary infiltrate gradually decreased within 4 wk. Three months later, his ulcerative colitis relapsed, and ileo-anal pouch surgery was performed. In cases of atypical pneumonia, without a proven infection, azathioprine-associated interstitial pneumonitis may be present, which heals after withdrawal of the drug. 相似文献
11.
Dermatomyositis (DM) patients might present with pulmonary involvement as the first manifestation or during the follow-up period. It is sometimes difficult to determine whether the clinical manifestations related with pulmonary involvement are due to DM or to an infectious process. We report a case of DM patient who developed interstitial pneumonitis induced by cytomegalovirus (CMV) while receiving immunosuppressive treatment. To the best of our knowledge, this is the second report in the literature of interstitial pneumonitis secondary to CMV infection in a patient with DM. 相似文献
12.
《Modern rheumatology / the Japan Rheumatism Association》2013,23(2):156-159
AbstractWe herein describe a 16-year-old boy with pneumomediastinum, pneumothorax, and subcutaneous emphysema as the initial symptoms of dermatomyositis (DM). His pneumomediastinum disappeared after strict bed rest and he was thereafter successfully treated with oral prednisolone and cyclosporine A. His condition was further complicated with mild interstitial lung disease, arrhythmia, and skin ulcers on his fingertips, right elbow, ear, and sacral region. Pneumomediastinum is a rare complication of DM and its pathogenesis remains unclear. We review the literature and discuss the possible mechanism of this disease. 相似文献
13.
We report a rare case of patient with dermatomyositis (DM) who developed spontaneous pneumomediastinum (PnM) and subcutaneous
emphysema. She was successfully treated with oral prednisolone and cyclosporine A (CsA). We reviewed the cases of PnM in patients
with DM treated with CsA. A review of four previously reported cases revealed that treatment with systemic glucocorticoid
and CsA was effective for the DM and PnM. We indicate that initial and early treatment of the patients with DM and PnM with
CsA enabled rapid tapering of the dose of glucocorticoid and improved the disease. 相似文献
14.
Fan-Pu Ji Zheng-Xiao Li Hong Deng Hong-An Xue Yuan Liu Min Li 《World journal of gastroenterology : WJG》2010,16(35):4394-4399
Interstitial pneumonitis(IP) is an uncommon pulmonary complication associated with interferon(IFN) therapy for chronic hepatitis C virus(HCV) infection.Pneumonitis can occur at any stage of HCV treatment,ranging from 2 to 48 wk,usually in the first 12 wk.Its most common symptoms are dyspnoea,dry cough,fever,fatigue,arthralgia or myalgia,and anorexia,which are reversible in most cases after cessation of IFN therapy with a mean subsequent recovery time of 7.5 wk.Bronchoalveolar lavage in combination with ches... 相似文献
15.
《Respiratory investigation》2020,58(4):262-268
BackgroundThe clinical characteristics and prognostic impact of complication with pneumomediastinum in patients with interstitial pneumonias (IPs) are not well studied due to the relatively limited nature of available reports. The purpose of this study was to clarify the characteristics and prognostic factors of IPs complicated with pneumomediastinum.MethodsConsecutive patients with IPs complicated with pneumomediastinum detected by computed tomography (CT) between July 1, 2011, and April 30, 2014 were retrospectively reviewed. Clinical data including symptoms associated with pneumomediastinum, laboratory data, lung function tests, treatments, and mortality were collected from medical records.ResultsForty-five patients (25 males, 20 females), including 32 with idiopathic IP (IIPs) and 13 connective tissue disease-associated interstitial lung diseases (CTD-ILDs) were identified. The median age of onset of pneumomediastinum was 72 years (interquartile range [IQR] 68–79 years). The most common symptom associated with occurrence of pneumomediastinum was appearance or worsening of dyspnoea. No specific treatment was performed for most (84%) of the cases. The median period between occurrence and improvement of pneumomediastinum was 29 days (IQR 5–69 days). Multivariate analysis revealed that IIPs and no improvement of pneumomediastinum were associated with poor prognosis.ConclusionsPatients with IIPs complicated with pneumomediastinum and those without improvement of pneumomediastinum had poor prognosis. 相似文献
16.
Yoshidome Y Morimoto S Tamura N Kobayashi S Tsuda H Hashimoto H Takasaki Y 《Clinical rheumatology》2007,26(9):1569-1570
We report a 62-year-old woman who suffered from polymyositis (PM) complicated with myasthenic crisis. Electromyography and
muscle biopsy indicated a diagnosis of PM; however, respiratory failure due to respiratory muscle weakness was seen in spite
of a normal serum creatine kinase (CK) level. The positive anti-acetylcholine receptor antibody led us to the diagnosis of
myasthenic crisis. PM with respiratory muscle weakness is rare. We suggest that the possibility of other neurological disorder
complications should be considered when PM patients have respiratory muscle weakness out of proportion to the serum CK level. 相似文献
17.
18.
Miwa Y Isozaki T Wakabayashi K Odai T Matsunawa M Yajima N Negishi M Ide H Kasama T Adachi M Hisayuki T Takemura T 《Modern rheumatology / the Japan Rheumatism Association》2008,18(2):208-211
A 74-year-old woman was experiencing rheumatoid arthritis complicated with interstitial pneumonitis (IP), and tacrolimus treatment
was started. She presented with dyspnea. Chest X-ray and computed tomography (CT) showed ground-glass opacity and IP. Although
tacrolimus was stopped, she died of respiratory failure. At autopsy, both the upper and lower lung fields showed usual IP
and the organizing stage of diffuse alveolar damage. The former is common, but the latter is uncommon, suggesting tacrolimus
may cause severe alveolar damage. 相似文献
19.
《Modern rheumatology / the Japan Rheumatism Association》2013,23(2):208-211
AbstractA 74-year-old woman was experiencing rheumatoid arthritis complicated with interstitial pneumonitis (IP), and tacrolimus treatment was started. She presented with dyspnea. Chest X-ray and computed tomography (CT) showed ground-glass opacity and IP. Although tacrolimus was stopped, she died of respiratory failure. At autopsy, both the upper and lower lung fields showed usual IP and the organizing stage of diffuse alveolar damage. The former is common, but the latter is uncommon, suggesting tacrolimus may cause severe alveolar damage. 相似文献