Unusual Bilateral Upper Extremity Pitting Edema in a Patient With Severe Dermatomyositis.

Curēus
Srikanth MukkeraSrikanth Naramala

Abstract

A 56-year-old Hispanic female presented with six weeks of progressive dysphagia, proximal muscle weakness, erythematous rash, bilateral upper extremity pitting edema, and left lower extremity pitting edema. She had preserved heart function and a normal echocardiogram (ECG). She presented with elevated creatine kinase (CK) and aldolase, with normal renal function. Muscle biopsy suggested idiopathic polymyositis. No blood clot was seen on deep vein thrombosis (DVT) ultrasound. The myositis antibody panel showed the NXP-2 antibody, which is usually seen in pediatric dermatomyositis cases. In our literature search, extremity pitting edema is an unusual way of presentation in dermatomyositis. She responded with intravenous immunoglobulin (IVIg) and high-dose intravenous steroids. We used azathioprine for remission maintenance; her rash recurred after tapering steroids. We resumed tapering steroid therapy and started her on weekly methotrexate along with daily azathioprine. With this combination therapy, her rash and muscle function improved. We successfully tapered her steroids. In our literature search, combination therapy with azathioprine and methotrexate was not reported. Our patient is tolerating this therapy very well.

References

Jun 15, 1996·The Journal of Clinical Investigation·N GoebelsR Hohlfeld
Dec 22, 2006·The Journal of Immunology : Official Journal of the American Association of Immunologists·Elizabeth M BradshawKevin C O'Connor
Jun 11, 2011·Arthritis Research & Therapy·Hector ChinoyRobert G Cooper
Aug 17, 2012·The Cochrane Database of Systematic Reviews·Patrick A GordonErnest H S Choy
Aug 29, 2013·Clinical and Experimental Immunology·P-O Carstens, J Schmidt
Jan 29, 2014·Journal of Autoimmunity·Luca IaccarinoAndrea Doria
May 17, 2014·Seminars in Arthritis and Rheumatism·José C MilisendaJosep M Grau
Oct 2, 2015·Clinical Reviews in Allergy & Immunology·Minoru SatohEdward K L Chan
Apr 23, 2016·Chest·Julie MorissetJoyce S Lee
Oct 19, 2016·RMD Open·Thomas SchwartzHelga Sanner
Dec 3, 2016·Seminars in Arthritis and Rheumatism·Sabrina Anh-Tu Hoa, Marie Hudson
Jul 12, 2017·Case Reports in Rheumatology·Zeeshan ButtAlim Ramji
Jun 6, 2018·Journal of Neuromuscular Diseases·Jens Schmidt
Dec 6, 2018·Case Reports in Rheumatology·Bing Han, Qiang Guo

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