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2.
Chest ; 159(3): e151-e154, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33678283

RESUMO

CASE PRESENTATION: A 64-year-old previously healthy man presented with 8 weeks of progressive dyspnea on exertion and cough. Prior to presentation, the patient was able to bicycle > 60 miles per week and work full-time in a home improvement store. He was up-to-date with age-appropriate cancer screening and immunizations, and home medications included famotidine for reflux and nonsteroidal antiinflammatories for osteoarthritis, both as-needed. He had no significant respiratory exposure, aside from previous work as an electrician. His symptoms began in mid-February 2020 amid the coronavirus disease 2019 pandemic, although he had no known exposure to the virus.


Assuntos
/diagnóstico , Frutose-Bifosfato Aldolase/sangue , Glucocorticoides/administração & dosagem , Pulmão/diagnóstico por imagem , Miosite , Troca Plasmática/métodos , Rituximab/administração & dosagem , Treonina-tRNA Ligase/imunologia , Autoanticorpos/sangue , Diagnóstico Diferencial , Progressão da Doença , Humanos , Imunossupressores/administração & dosagem , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/etiologia , Miosite/sangue , Miosite/diagnóstico , Miosite/fisiopatologia , Miosite/terapia , Oxigenoterapia/métodos , Prognóstico , Resultado do Tratamento
4.
Rev Med Suisse ; 17(729): 482-486, 2021 Mar 10.
Artigo em Francês | MEDLINE | ID: mdl-33689244

RESUMO

Inflammatory myopathies are characterized by muscle weakness, occasionally pain, and an inflammatory infiltrate of the skeletal muscle. Despite the description of novel autoantibodies and advances in imaging, the lack of universal consensus on classification criteria and routine clinical use of validated outcome measures has direct implications on treatment trials and observational registries. In this article we discuss the differential diagnosis and prognosis of the idiopathic inflammatory myopathies.


Assuntos
Miosite , Autoanticorpos , Diagnóstico Diferencial , Humanos , Músculo Esquelético , Miosite/diagnóstico , Prognóstico
5.
Brain Nerve ; 73(2): 117-125, 2021 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-33561826

RESUMO

The classification criteria of idiopathic inflammatory myopathy in the past include the criteria defined phenotypically by Peter and Bohan in 1975 and the criteria defined based on pathological findings in affected muscles. New criteria were defined by international researchers, including the author of this article, from multiple fields to be used widely in different fields in 2017. The criteria were approved by rheumatological societies in Europe and the United States, and validated as excellent criteria in a Japanese cohort. It is known that the criteria used for etiological studies and those for diagnosis should be different in their stringency. In the new criteria, the stringency can be set freely by the users to be used for a wide range of purposes.


Assuntos
Miosite , Estudos de Coortes , Europa (Continente) , Humanos , Miosite/diagnóstico
6.
Brain Nerve ; 73(2): 137-146, 2021 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-33561828

RESUMO

Dermatomyositis and antisynthetase syndrome are among idiopathic inflammatory myopathies (myositis) that have skin lesions. In these disorders, skin symptoms often appear as the initial manifestations, and thus, their evaluation is critical for diagnosis. Two components, "site" and "properties," are important for understanding the skin manifestations in myositis. The rash in these disorders is induced by Koebner's phenomenon, and is most frequently observed on the hands and face. Recent studies have shown that myositis-specific autoantibodies are useful tools for the diagnosis and classification of these diseases, as they are closely correlated with the clinical and histopathological phenotypes of myositis. It has recently become clear that each antibody is associated with characteristic skin manifestations, especially related to the properties of the skin lesions.


Assuntos
Dermatomiosite , Miosite , Autoanticorpos , Dermatomiosite/complicações , Dermatomiosite/diagnóstico , Humanos , Miosite/complicações , Miosite/diagnóstico , Fenótipo
7.
Brain Nerve ; 73(2): 147-159, 2021 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-33561829

RESUMO

In the field of neurology, idiopathic inflammatory myopathy has been classified into four sub-categories, namely, dermatomyositis, anti-synthetase syndrome, inclusion body myositis, and immune-mediated necrotizing myopathy (IMNM), based upon histological and serological findings. Among them, IMNM has features similar to muscular dystrophy, and it may thus be difficult to differentiate between these two conditions, not only clinically but also pathologically, especially in chronic cases and pediatric patients. This is partly because the main pathological feature of both IMNM and muscular dystrophy is myofiber necrosis and regeneration. Furthermore, IMNM patients with anti-SRP antibodies tend to have more prominent muscle atrophy, especially in the shoulder girdle, which mimics the muscle involvement pattern in facioscapulohumeral muscular dystrophy. Some IMNM patients with anti-HMGCR antibodies have onset in their childhood or even in infancy, and may be misdiagnosed with muscular dystrophy. On the other hand, some muscular dystrophies have been reported to show more prominent lymphocyte infiltration than others, which may also mislead muscle pathologists. Nevertheless, these conditions can be distinguished using the relevant histological evaluations, including muscle immunohistochemistry for the MHC and C5b-9 antigens, in addition to appropriate clinical and laboratory examinations including muscle MRI and autoantibody testing.


Assuntos
Doenças Musculares , Distrofias Musculares , Miosite de Corpos de Inclusão , Miosite , Autoanticorpos , Criança , Humanos , Músculo Esquelético , Distrofias Musculares/diagnóstico , Miosite/diagnóstico
9.
BMC Pulm Med ; 21(1): 11, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407281

RESUMO

BACKGROUND: Anti-synthetase syndrome (ASS) is an uncommon immune-mediated entity characterized by myositis, interstitial lung disease (ILD), non-erosive arthritis, and less common features such as fever, Raynaud's phenomenon, and skin changes in association with anti-aminoacyl-transfer-RNA antibodies, most commonly anti-Jo-1 antibodies. CASE PRESENTATION: We present a challenging and rare case of ASS-associated ILD presenting with unexplained respiratory symptoms and bilateral infiltrates on chest imaging during the COVID-19 pandemic. High clinical suspicion for ASS with early appropriate therapy with corticosteroids and immunosuppressive agents led to marked clinical improvement. CONCLUSION: High index of suspicion for ASS is mandated in patients with unexplained ILD. A comprehensive autoimmune work-up is important as an early treatment with corticosteroids with or without immunomodulators improves patient outcomes and survival in an otherwise poor prognostic disease.


Assuntos
Autoanticorpos/imunologia , Pulmão/diagnóstico por imagem , Miosite/diagnóstico , Pandemias , Doenças Raras , Comorbidade , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Miosite/epidemiologia , Miosite/imunologia , Prognóstico
10.
Muscle Nerve ; 63(3): E21-E24, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33314145

Assuntos
/efeitos adversos , Melanoma/tratamento farmacológico , Doenças Musculares/induzido quimicamente , Miosite/induzido quimicamente , Miotonia Congênita/complicações , Distrofia Miotônica/complicações , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Neoplasias Cutâneas/tratamento farmacológico , Idoso , Anticorpos Monoclonais Humanizados/efeitos adversos , Cardiomiopatia Dilatada , Canais de Cloreto/genética , Conectina/genética , Transtornos de Deglutição/induzido quimicamente , Transtornos de Deglutição/complicações , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/fisiopatologia , Eletrodiagnóstico , Eletromiografia , Humanos , Ipilimumab/efeitos adversos , Imagem por Ressonância Magnética , Masculino , Melanoma/secundário , Doenças Musculares/complicações , Doenças Musculares/genética , Doenças Musculares/fisiopatologia , Miosite/complicações , Miosite/diagnóstico , Miosite/fisiopatologia , Miotonia Congênita/diagnóstico , Miotonia Congênita/genética , Miotonia Congênita/fisiopatologia , Distrofia Miotônica/diagnóstico , Distrofia Miotônica/fisiopatologia , Condução Nervosa , Nivolumabe/efeitos adversos , Parestesia/induzido quimicamente , Parestesia/complicações , Parestesia/fisiopatologia , Doenças do Sistema Nervoso Periférico/complicações , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/fisiopatologia , Proteínas de Ligação a RNA/genética , Neoplasias Cutâneas/patologia , Neoplasias da Coluna Vertebral/tratamento farmacológico , Neoplasias da Coluna Vertebral/secundário
12.
BMC Infect Dis ; 20(1): 768, 2020 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-33069216

RESUMO

BACKGROUND: Cytomegalovirus (CMV) is a double stranded DNA virus and ubiquitous in nature. Association of Guillain-Barre syndrome (GBS) and CMV is well known but CMV acute myositis is a rare condition. Restriction of movements of limbs due to severe pain in myositis may obscure the diagnosis of GBS and this may easily miss. CASE PRESENTATION: Here we describe a 29-year-old male presenting with pain and swelling of bilateral lower limbs which progressed rapidly with increasing serum creatine kinase levels with positive IgM CMV antibodies. In view of no improvement in clinical condition, patient was further evaluated and found to have concurrent GBS. He was treated with plasmapheresis and improved. CONCLUSION: Cytomegalovirus infection presenting as acute myositis is a uncommon and further association with GBS is a rare occurrence.


Assuntos
Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/diagnóstico , Citomegalovirus/imunologia , Síndrome de Guillain-Barré/complicações , Síndrome de Guillain-Barré/diagnóstico , Miosite/complicações , Miosite/diagnóstico , Doença Aguda , Adulto , Anticorpos Antivirais/sangue , Infecções por Citomegalovirus/terapia , Erros de Diagnóstico , Síndrome de Guillain-Barré/terapia , Humanos , Imunoglobulina M/sangue , Masculino , Miosite/terapia , Miosite/virologia , Dor , Plasmaferese , Resultado do Tratamento
13.
Curr Opin Rheumatol ; 32(6): 553-561, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32890032

RESUMO

PURPOSE OF REVIEW: We have reviewed the literature to identify significant advances related to disease activity and damage in the idiopathic inflammatory myopathies (IIMs) from January 2019 to July 2020. RECENT FINDINGS: New observations in the field from 2019 to 2020 have resulted in a better understanding of the clinical association and pathogenic origins of IIM. The use of patient-reported outcome measures and perspectives, identifying biomarkers and making better use of autoantibody testing are summarized. Basic sciences have led to an improved understanding of the role of NETosis in calcinosis, and of interferon type 1, in IIM. Preliminary insights are offered into Covid-19 in the setting of IIM, and the use of potential tools for monitoring disease remotely, which may assume larger importance for optimal disease management during a global pandemic. The wider exploration of newer imaging modalities and the use of nailfold capillaroscopy is a further step in better management of the condition. SUMMARY: The summarized research in IIM is a step forward in being able to further define, and to distinguish disease activity from damage, in order to potentially aid future clinical diagnosis and management in this challenging disease.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Monitorização Fisiológica/métodos , Miosite/diagnóstico , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Comorbidade , Humanos , Miosite/epidemiologia , Pandemias
14.
J Vet Diagn Invest ; 32(4): 611-615, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32687008

RESUMO

The only Sarcocystis species currently known to inhabit the fibers of skeletal and cardiac muscles in horses are S. fayeri, S. bertrami, and S. asinus. We describe herein the invasion of myofibers in a horse by S. gigantea, a sheep-specific species with low virulence in the original host. A hunter gelding was referred to a veterinary surgeon in Newmarket (UK). The anamnestic data reported that the horse had an initial history of swelling of the right forelimb with fluid on the front of the carpus and edema spreading up the forearm. Subsequently, 2 firm lumps were found on the left pectoral muscle adjacent to the axilla of the left forelimb. Histologic examination of biopsies from the lumps revealed multifocal granulomatous eosinophilic myositis associated with intact and degenerate encysted parasites, consistent with Sarcocystis spp. Based on amplification and DNA sequencing of the 18S rRNA gene obtained from formalin-fixed, paraffin-embedded tissue blocks, S. gigantea was identified. The presence of sarcocysts in equine skeletal muscles has been considered an incidental finding, and there are only sporadic associated reports of myositis. Our finding suggests that some Sarcocystis spp. have a wider intermediate host range than believed previously, and that Sarcocystis of other species (not considered horse-associated) can invade the muscle fibers of equids, leading to myositis.


Assuntos
Doenças dos Cavalos/patologia , Miosite/veterinária , Sarcocystis/isolamento & purificação , Sarcocistose/veterinária , Animais , Cavalos , Masculino , Distrofia Muscular do Cíngulo dos Membros/diagnóstico , Distrofia Muscular do Cíngulo dos Membros/parasitologia , Distrofia Muscular do Cíngulo dos Membros/patologia , Miosite/diagnóstico , Miosite/parasitologia , Miosite/patologia , RNA de Protozoário/análise , RNA Ribossômico 18S/análise , Sarcocistose/patologia , Análise de Sequência de DNA/veterinária
15.
Neurol Clin ; 38(3): 661-678, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32703475

RESUMO

Inflammatory myopathies are a group of immune-mediated muscle disorders comprising dermatomyositis; polymyositis; overlap myositis, including antisynthetase syndromes and nonspecific myositis, immune-mediated necrotizing myopathies, and sporadic inclusion body myositis. They are now much more eloquently classified both pathologically and clinically because of the discovery of several myositis-specific and myositis-associated antibodies. These antibodies also aid in choosing the best treatment options in each case. Based on the initial classifications of inflammatory myopathies, inclusion body myositis, overlap myositis, and necrotizing myositis were all included in the polymyositis group. This article discusses cases, diagnostic tools, associated antibodies, and pathology.


Assuntos
Autoanticorpos/sangue , Miosite/sangue , Miosite/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Autoanticorpos/imunologia , Feminino , Humanos , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Miosite/imunologia , Miosite de Corpos de Inclusão/sangue , Miosite de Corpos de Inclusão/diagnóstico , Miosite de Corpos de Inclusão/imunologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-32518172

RESUMO

OBJECTIVE: To present the COVID-19-associated GBS, the prototypic viral-triggered autoimmune disease, in the context of other emerging COVID-19-triggered autoimmunities, and discuss potential concerns with ongoing neuroimmunotherapies. METHODS: Eleven GBS cases in four key COVID-19 hotspots are discussed regarding presenting symptoms, response to therapies and cross-reactivity of COVID spike proteins with nerve glycolipids. Emerging cases of COVID-19-triggered autoimmune necrotizing myositis (NAM) and encephalopathies are also reviewed in the context of viral invasion, autoimmunity and ongoing immunotherapies. RESULTS: Collective data indicate that in this pandemic any patient presenting with an acute paralytic disease-like GBS, encephalomyelitis or myositis-even without systemic symptoms, may represent the first manifestation of COVID-19. Anosmia, ageusia, other cranial neuropathies and lymphocytopenia are red flags enhancing early diagnostic suspicion. In Miller-Fisher Syndrome, ganglioside antibodies against GD1b, instead of QG1b, were found; because the COVID-19 spike protein also binds to sialic acid-containing glycoproteins for cell-entry and anti-GD1b antibodies typically cause ataxic neuropathy, cross-reactivity between COVID-19-bearing gangliosides and peripheral nerve glycolipids was addressed. Elevated Creatine Kinase (>10,000) is reported in 10% of COVID-19-infected patients; two such patients presented with painful muscle weakness responding to IVIg indicating that COVID-19-triggered NAM is an overlooked entity. Cases of acute necrotizing brainstem encephalitis, cranial neuropathies with leptomeningeal enhancement, and tumefactive postgadolinium-enhanced demyelinating lesions are now emerging with the need to explore neuroinvasion and autoimmunity. Concerns for modifications-if any-of chronic immunotherapies with steroids, mycophenolate, azathioprine, IVIg, and anti-B-cell agents were addressed; the role of complement in innate immunity to viral responses and anti-complement therapeutics (i.e. eculizumab) were reviewed. CONCLUSIONS: Emerging data indicate that COVID-19 can trigger not only GBS but other autoimmune neurological diseases necessitating vigilance for early diagnosis and therapy initiation. Although COVID-19 infection, like most other viruses, can potentially worsen patients with pre-existing autoimmunity, there is no evidence that patients with autoimmune neurological diseases stable on common immunotherapies are facing increased risks of infection.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/etiologia , Miosite/diagnóstico , Miosite/etiologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Doenças Autoimunes do Sistema Nervoso/diagnóstico , Doenças Autoimunes do Sistema Nervoso/etiologia , Doenças Autoimunes do Sistema Nervoso/imunologia , Betacoronavirus/imunologia , Infecções por Coronavirus/imunologia , Feminino , Síndrome de Guillain-Barré/imunologia , Humanos , Masculino , Miosite/imunologia , Pandemias , Pneumonia Viral/imunologia
18.
J Neurovirol ; 26(2): 143-148, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32447630

RESUMO

A pandemic due to novel coronavirus arose in mid-December 2019 in Wuhan, China, and in 3 months' time swept the world. The disease has been referred to as COVID-19, and the causative agent has been labelled SARS-CoV-2 due to its genetic similarities to the virus (SARS-CoV-1) responsible for the severe acute respiratory syndrome (SARS) epidemic nearly 20 years earlier. The spike proteins of both viruses dictate tissue tropism using the angiotensin-converting enzyme type 2 (ACE-2) receptor to bind to cells. The ACE-2 receptor can be found in nervous system tissue and endothelial cells among the tissues of many other organs.Neurological complications have been observed with COVID-19. Myalgia and headache are relatively common, but serious neurological disease appears to be rare. No part of the neuraxis is spared. The neurological disorders occurring with COVID-19 may have many pathophysiological underpinnings. Some appear to be the consequence of direct viral invasion of the nervous system tissue, others arise as a postviral autoimmune process, and still others are the result of metabolic and systemic complications due to the associated critical illness. This review addresses the preliminary observations regarding the neurological disorders reported with COVID-19 to date and describes some of the disorders that are anticipated from prior experience with similar coronaviruses.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Encefalite Viral/epidemiologia , Meningite/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Betacoronavirus/genética , Betacoronavirus/metabolismo , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Encefalite Viral/complicações , Encefalite Viral/diagnóstico , Encefalite Viral/virologia , Cefaleia/complicações , Cefaleia/diagnóstico , Cefaleia/epidemiologia , Cefaleia/virologia , Interações Hospedeiro-Patógeno/genética , Humanos , Meningite/complicações , Meningite/diagnóstico , Meningite/virologia , Mialgia/complicações , Mialgia/diagnóstico , Mialgia/epidemiologia , Mialgia/virologia , Miosite/complicações , Miosite/diagnóstico , Miosite/epidemiologia , Miosite/virologia , Sistema Nervoso/patologia , Sistema Nervoso/virologia , Peptidil Dipeptidase A/genética , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Ligação Proteica , Receptores Virais/genética , Receptores Virais/metabolismo , Glicoproteína da Espícula de Coronavírus/genética , Glicoproteína da Espícula de Coronavírus/metabolismo , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/virologia , Internalização do Vírus
19.
Z Rheumatol ; 79(6): 578-583, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32462339

RESUMO

Rheumatologists are often confronted by patients with muscle weakness and elevated creatine kinase (CK) levels. Myositis cannot always be determined to be the cause of the complaints. This article presents two cases from our hospital where the diagnosis could only be determined by muscle biopsy. In the first case the patient presented with muscle weakness, pathological weight loss and a significant increase in CK levels. A muscle biopsy revealed an immune-mediated necrotizing myopathy (IMNM) caused by anti-3-hydroxy-3-methyl-gulatryl-CoA reductase (HMG-CoA reductase) autoantibodies due to the intake of statins. The second patient presented with cramp-like and burning muscle pain and weakness of the extremities without a relevant increase in CK level. Myoadenylate deaminase deficiency was also detected by muscle biopsy, and further confirmed by genetic testing.


Assuntos
Creatina Quinase/sangue , Debilidade Muscular , Miosite , Autoanticorpos/imunologia , Doenças Autoimunes , Humanos , Debilidade Muscular/sangue , Debilidade Muscular/diagnóstico , Doenças Musculares/sangue , Doenças Musculares/diagnóstico , Miosite/sangue , Miosite/diagnóstico , Necrose
20.
Best Pract Res Clin Rheumatol ; 34(1): 101486, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32063440

RESUMO

The idiopathic inflammatory myopathies are a group of heterogeneous autoimmune connective tissue diseases. Despite increase in the understanding of these conditions, securing a timely diagnosis and accurate subtype classification remains difficult in some cases. This has important implications for patients, where delayed or inappropriate treatments can have a negative effect on outcomes. Several conditions can mimic myositis, including metabolic myopathies, genetic myopathies and neurological disease. In addition, the heterogeneity within the idiopathic inflammatory myopathy spectrum can also create diagnostic confusion, referred to here as 'myositis chameleons'. This includes inclusion body myositis, immune-mediated necrotizing myopathy, hypomyopathic variants of anti-synthetase syndrome and overlap disease. We highlight the importance of a thorough diagnostic workup, refer to updated classification criteria and emphasize the importance of myositis autoantibody testing. Where diagnostic doubt exists, the involvement of a specialist centre and a multidisciplinary team is vital.


Assuntos
Doenças Autoimunes , Miosite de Corpos de Inclusão , Miosite , Autoanticorpos , Doenças Autoimunes/diagnóstico , Humanos , Miosite/diagnóstico
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