Steroid Induced Myopathy in Dermatomyositis Patients

Symmetrical proximal weakness and characteristic dermatologic manifestations are important in the diagnosis of dermatomyositis. We report a case of atypical presentation of dermatomyositis due to previous steroid use and also report steroid-induced myopathy which may occur from steroid administration during the course of treatment. A 77-year-old man, previous steroid user, showed rapidly progressing weakness after abruptly stopped medication. He has presented erythematous papule on face and anterior chest but no heliotrope rash and Gottron's papules were observed. Muscle enzyme (creatine kinase) concentration is increased, and needle electromyography shows increased spontaneous activity on proximal limb muscle. The muscle biopsy confirmed dermatomyositis. During the course of treatment, he revealed persistent weakness despite the continuous steroid use and stable creatine kinase level. Electrodiagnostic study suggests steroid-induced myopathy and after tapering steroid, proximal muscle strength improved. This case reports the effect of steroid use on dermatomyositis patients and a process of diagnosing coexisting steroid induced myopathy during treatment.

Successful treatment of bronchiolitis obliterans organizing pneumonia associated with polymyositis with a steroid inhaler and low-dose cyclophosphamide / 대한내과학회지

Polymyositis is an inflammatory connective tissue disease involving, predominantly, skeletal muscle. Occasionally, it is complicated by serious interstitial pneumonia. The presence of interstitial pneumonia affects the prognosis and contributes substantially to the morbidity and mortality. Although the treatment recommendations for interstitial pneumonia in polymyositis are still not optimal, high-dose steroid or immunosuppressive agents such as methotrexate, azathioprine, cyclosporine A, or cyclophosphamide alone or in combination are effective in myositis-associated interstitial pneumonia in many cases. Nevertheless, the relative frequency of complications, such as opportunistic infection, steroid-induced myopathy, and steroid psychosis, limits the use of high-dose steroid or immunosuppressive regimens. Here, we describe our experience of combination treatment with a steroid inhaler and low-dose cyclophosphamide in a patient with bronchiolitis obliterans organizing pneumonia associated with polymyositis who developed steroid-induced myopathy during initial high-dose steroid and cyclosporine A treatment.