A case of amyopathic dermatomyositis with acute interstitial pneumonia (DAD pattern)

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A case of amyopathic dermatomyositis with acute interstitial pneumonia (DAD pattern)

Þ¹Department of Dermatology, Kanto Medical Center NTT EC

Þ²Department of Dermatology, Kanazawa University Graduate School of Medical Science (Received March 22, 2004)

summary

A 61­year­old man was admitted to our hospital because of edematous erythema on his upper eyelids and dry cough. No subjective nor objective ˆndings suggestive of skeletal muscle involvement, such as muscle weakness and elevated levels of aldolase and creatine phosphokinase were noted. Chest high­resolution computed tomography rev­

ealed a ground glass opacity and consolidation of his lower lung. Skin biopsy ˆndings were compatible with der­

matomyositis. Therefore, he was diagnosed as amyopathic dermatomyositis(ADM)with acute interstitial pneumonia and treatment with steroid pulse therapy was started. Since histological evaluation showed diŠuse alveolar damage dur­

ing the initial treatment, the treatment was changed into the combination therapy of prednisolone and cyclosporine.

However, his acute interstitial pneumonia did not respond to this treatment and passed away by aggravation of a breathing state and concurrence of disseminated intravascular coagulation. Japanese patients with ADM have been shown to be more frequently associated with intractable acute interstitial pneumonia than Caucasian patients, suggest­

ing that the racial diŠerence in‰uences the occurrence of acute interstitial pneumonia in ADM. Since autoantibodies speciˆc for ADM have not been detected, we performed immunoprecipitcation analysis using³⁵S methionine­labeled K562 cells to identify them. His sera immunoprecipated a polypeptide of 140 kDa. The 140 kDa polypeptide might be one of autoantibodies speciˆc for ADM with acute interstitial pneumonia, although future analysis using a larger num­

ber of patients with ADM will be required to conˆrm this result.

Key words\amyopathic dermatomyositis; interstitial pneumonia; 140 kDa polypeptide; immunoprecipitcation

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