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1.
Acta Medica (Hradec Kralove) ; 65(1): 37-40, 2022.
Article in English | MEDLINE | ID: covidwho-1924737

ABSTRACT

Anti-melanoma differentiation-associated gene-5 (MDA-5) antibody is an autoantibody found in patients with dermatomyositis. These antibody-positive patients are clinically characterized by complications of rapidly progressive interstitial pneumonia resistant to treatment and with poor prognosis. We describe herein a patient with MDA-5 antibody-positive interstitial lung disease, which progressed rapidly to death after a period of slow progress. Recently, attention has been paid to the similarities in clinical courses and CT images between MDA-5 antibody-positive interstitial lung disease and coronavirus disease 2019 (COVID-19)-associated pneumonia. Patients with MDA-5 antibody do not always have diffuse and evenly distributed bilateral opacities at the time of first presentation. This patient had significant laterality of such opacities. It should be considered that MDA-5 antibody-positive patients with such laterality in opacities might progress rapidly. Chest physicians, dermatologists, and dermatologists need to be aware of the characteristics of the disease for optimal treatment choices.


Subject(s)
COVID-19 , Dermatomyositis , Lung Diseases, Interstitial , Autoantibodies , COVID-19/complications , Dermatomyositis/complications , Humans , Lung Diseases, Interstitial/complications
2.
Eur J Med Res ; 27(1): 68, 2022 May 15.
Article in English | MEDLINE | ID: covidwho-1849783

ABSTRACT

BACKGROUND: Dermatomyositis is a rare idiopathic inflammatory disease with diverse presentations that can have varying degrees of cutaneous and systemic involvement. This phenotypic heterogeneity makes DM a therapeutic challenge. Some therapeutic drugs, such as hormones and immunosuppressants, have poor therapeutic effects. In recent years, tofacitinib has been reported to be effective in the treatment of dermatomyositis. CASE PRESENTATION: We report a case of anti-MDA5 antibody-positive dermatomyositis that was relieved after treatment with tofacitinib, during which gallbladder gangrene and suppurative cholecystitis occurred. After cholecystectomy, we continued to use tofacitinib and achieved a good therapeutic effect. CONCLUSIONS: Tofacitinib is effective in the treatment of anti-MDA5 antibody-positive dermatomyositis, but the risk of infection is increased. It can still be used after infection control. Close follow-up should be performed during the use of tofacitinib.


Subject(s)
Cholecystitis , Dermatomyositis , Lung Diseases, Interstitial , Autoantibodies , Cholecystitis/complications , Cholecystitis/drug therapy , Dermatomyositis/complications , Dermatomyositis/drug therapy , Humans , Interferon-Induced Helicase, IFIH1 , Lung Diseases, Interstitial/complications , Lung Diseases, Interstitial/drug therapy , Piperidines , Pyrimidines
3.
Reumatismo ; 74(1)2022 May 03.
Article in English | MEDLINE | ID: covidwho-1835038

ABSTRACT

Borges et al. have recently reported the first case of a dermatomyositis onset in close association with established coronavirus disease 2019 (COVID-19). Similarly, we report a patient who, on the contrary, had COVID-19 following early established dermatomyositis. We report prospectively the outcome of her disease.


Subject(s)
COVID-19 , Dermatomyositis , COVID-19/complications , Dermatomyositis/complications , Female , Humans
6.
Curr Opin Rheumatol ; 33(6): 514-521, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1402704

ABSTRACT

PURPOSE OF REVIEW: The aim of the present review is to analyze the link between autoimmune diseases and environmental factors, in particular severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19) as it shares numerous features with the interstitial lung disease associated with connective tissue diseases positive for rare autoantibodies directed at highly specific autoantigens (i.e., MDA5 and RIG1) among the intracellular sensors of SARS-CoV-2 in the innate response against viruses. RECENT FINDINGS: As shown in recent publications and in our original data, specific autoantibodies may be functionally relevant to COVID-19 infection. We evaluated sera from 35 hospitalized patients with COVID-19 to identify antinuclear antibodies and autoantibodies directed against specific antigenic targets, and we identified anti-nuclear antibodies (ANA) in 20/35 of patients with COVID-19 (57%), in patients with need for supplemental oxygen (90% vs. 20% in ANA-negative cases; P < 0.0001). In 7/35 COVID-19 sera, we detected anti-MJ/NXP2 (n = 3), anti-RIG1 (n = 2), anti-Scl-70/TOPO1 (n = 1), and anti-MDA5 (n = 1), overall associated with a significantly worse pulmonary involvement at lung computerized tomography scans. Eleven (31%) patients were positive for antibodies against the E2/E3 subunits of mitochondrial pyruvate dehydrogenase complex. SUMMARY: Viral infections such as COVID-19 are associated with ANA and autoantibodies directed toward antiviral signaling antigens in particular in patients with worse pulmonary involvement.


Subject(s)
COVID-19 , Connective Tissue Diseases , Dermatomyositis , Antibodies, Antinuclear , Autoantibodies , Dermatomyositis/complications , Humans , SARS-CoV-2
8.
Clin Dermatol ; 39(1): 56-63, 2021.
Article in English | MEDLINE | ID: covidwho-1300691

ABSTRACT

Autoimmune connective tissue diseases are a heterogeneous group of clinical entities sharing a common feature-an impairment of structural components like collagen and elastin, arising by autoimmune mechanisms. Because most patients are on a long-term immunosuppressive therapy, which renders them vulnerable to infections, a new challenge appears in front of physicians in the coronavirus disease 2019 (COVID-19) era. Immune mechanisms are substantial for the control and ceasing of viral infections, and their impairment may cause serious complications; however, data from immunosuppressed transplant patients do not reveal a higher frequency or diseases' severity in those infected by COVID-19. Several immunotherapies used to treat autoimmune connective tissue diseases favorably modulate the immune response of severe acute respiratory syndrome coronavirus (SARS-CoV-2)-infected patients. The present review highlights the problems of susceptibility, severity, and therapeutic options in patients with autoimmune connective tissue diseases during the COVID-19 pandemic. The relationship between autoimmune connective tissue diseases and COVID-19 infection is explained with antiviral protection genes expression, hypercytokinemia, and lymphohistiocytosis/macrophage activation mechanisms. Recommendations concerning therapy for prevention during the pandemic period or in case of concomitant COVID-19 infection are also presented. Clinical trials are ongoing regarding COVID-19 therapy blocking the cytokine response. © 2021 Elsevier Inc. All rights reserved.


Subject(s)
COVID-19/complications , Dermatomyositis , Lupus Erythematosus, Systemic , Scleroderma, Systemic , Vasculitis , Antibodies, Monoclonal, Humanized/therapeutic use , Antimalarials/therapeutic use , COVID-19/epidemiology , Dermatomyositis/complications , Dermatomyositis/drug therapy , Dermatomyositis/immunology , Disease Susceptibility , Humans , Hydroxychloroquine/therapeutic use , Immunosuppressive Agents/therapeutic use , Janus Kinase Inhibitors/therapeutic use , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/drug therapy , Lupus Erythematosus, Systemic/immunology , Patient Acuity , SARS-CoV-2 , Scleroderma, Systemic/drug therapy , Scleroderma, Systemic/immunology , Thromboembolism/etiology , Vasculitis/drug therapy
10.
BMC Pulm Med ; 20(1): 304, 2020 Nov 19.
Article in English | MEDLINE | ID: covidwho-934264

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has reach pandemic proportions globally. For patients with symptoms of fever and cough accompanied by rapid lung damage progression, COVID-19 needs to be distinguished from interstitial lung disease (ILD) attributed to connective tissue disease (CTD), especially dermatomyositis (DM)/clinical amyopathic dermatomyositis (CADM) associated rapidly progressive interstitial lung disease (RP-ILD). CASE PRESENTATION: We report a case of a woman observed with fever, cough, and rapid lung damage during the epidemic. The patient had a suspicious epidemiological history, and her chest CT scans showed lung damage similar to that caused by COVID-19, but anti-Ro52 antibody was strongly positive. She was diagnosed with CADM associated RP-ILD and died 1 month later. CONCLUSIONS: During the COVID-19 epidemic, it is critical to carefully assess patients with CTD related ILD, especially RP-ILD associated with CADM. Repeated nucleic acid tests for COVID-19 are necessary to achieve accurate case diagnosis. High-resolution CT (HRCT) of the chest is presently deemed an inefficient technique to distinguishing between COVID-19 and CADM associated RP-ILD. The characteristic rashes of dermatomyositis require careful observation and can often provide diagnostic clues. For patients with CADM, a high titers of anti-Ro52 antibody may be related to the pathogenesis of RP-ILD, suggesting a poor prognosis.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Dermatomyositis/complications , Dermatomyositis/diagnosis , Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/etiology , Pneumonia, Viral/complications , COVID-19 , Coronavirus Infections/diagnosis , Dermatomyositis/therapy , Diagnosis, Differential , Fatal Outcome , Female , Humans , Lung Diseases, Interstitial/therapy , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , SARS-CoV-2
11.
Mod Rheumatol Case Rep ; 5(1): 101-107, 2021 01.
Article in English | MEDLINE | ID: covidwho-917630

ABSTRACT

Anti-melanoma differentiation-associated gene 5 juvenile dermatomyositis (anti-MDA5 JDM) is associated with high risk of developing rapidly progressive interstitial lung disease (RP-ILD). Here we report an 11-year-old girl with anti-MDA5 JDM and RP-ILD which led to a fatal outcome, further aggravated by SARS-CoV-2 infection. She was referred to our hospital after being diagnosed with anti-MDA5 JDM and respiratory failure due to RP-ILD. On admission, fibrobronchoscopy with bronchoalveolar lavage (BAL) revealed Pneumocystis jirovecii infection so treatment with intravenous trimethoprim-sulfamethoxazole was initiated. Due to RP-ILD worsening, immunosuppressive therapy was intensified using methylprednisolone pulses, cyclophosphamide, tofacitinib and intravenous immunoglobulin without response. She developed severe hypoxemic respiratory failure, pneumomediastinum and pneumothorax, further complicated with severe RP-ILD and cervical subcutaneous emphysema. Three real-time RT-PCR for SARS-CoV-2 were made with a negative result. In addition, she was complicated with a secondary hemophagocytic lymphohistiocytosis and a fourth real-time PCR for SARS-CoV-2 performed in BAS sample was positive. Despite aggressive treatment of RP-ILD due to anti-MDA5 JDM, there was no improvement of respiratory failure in the following days and patient developed refractory septic shock and died. Anti-MDA5 JDM patients with RP-ILD have a poor prognosis with a high mortality rate. For this reason, intensive immunosuppressive therapy is essential including the use of promising drugs such as tofacitinib. COVID-19 in children with underlying health conditions like anti-MDA5 JDM may still be at risk for disease and severe complications.


Subject(s)
COVID-19/complications , Dermatomyositis/complications , Immunosuppressive Agents/therapeutic use , Lung Diseases, Interstitial/complications , Lymphohistiocytosis, Hemophagocytic/etiology , Pneumonia, Pneumocystis/complications , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Alanine/analogs & derivatives , Alanine/therapeutic use , Anti-Bacterial Agents/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Antiviral Agents/therapeutic use , Autoantibodies/immunology , Bronchoscopy , COVID-19/therapy , COVID-19 Nucleic Acid Testing , Child , Cyclophosphamide/therapeutic use , Dermatomyositis/drug therapy , Dermatomyositis/immunology , Disease Progression , Fatal Outcome , Female , Humans , Hydroxychloroquine/therapeutic use , Immunocompromised Host , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Interferon-Induced Helicase, IFIH1/immunology , Lung/diagnostic imaging , Lung Diseases, Interstitial/diagnostic imaging , Lung Diseases, Interstitial/immunology , Lung Diseases, Interstitial/therapy , Lymphohistiocytosis, Hemophagocytic/immunology , Mediastinal Emphysema/etiology , Methylprednisolone/therapeutic use , Piperidines/therapeutic use , Pneumonia, Pneumocystis/immunology , Pneumothorax/etiology , Pyrimidines/therapeutic use , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Shock, Septic/etiology , Subcutaneous Emphysema/etiology , Tomography, X-Ray Computed , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
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