RESUMO
INTRODUCTION: This case report signifies the need to systemically assess antimalarial toxicity in those undergoing long-term treatment. CASE REPORT: A 59-year-old man with a history of ischemic-labeled heart disease revealed by conduction disorders and cutaneous lupus treated initially with hydroxychloroquine followed by chloroquine consulted for asthenia and weight loss. Clinically, he had a muscular atrophy, a motor deficit, and an abolition of the osteo-tendinous reflexes in the lower limbs. Adverse drug effects of the antimalarial therapy were suspected-specifically, muscular and cardiac toxicity. The diagnosis was confirmed with a muscle biopsy, which showed typical and florid vacuolar myopathy. Cessation of the drug resulted in a slow regression of symptoms. CONCLUSION: Cardiac and muscular toxicity related to antimalarials are rare and sometimes fatal; thus, they must be systematically assessed in a patient with several years of exposure. A muscle biopsy could be sufficient to allow for the diagnosis.
Assuntos
Antimaláricos/efeitos adversos , Astenia , Cardiotoxicidade/diagnóstico , Doenças Musculares/induzido quimicamente , Doenças Musculares/diagnóstico , Redução de Peso , Astenia/induzido quimicamente , Astenia/diagnóstico , Biópsia , Cardiotoxicidade/etiologia , Cardiotoxicidade/patologia , Diagnóstico Diferencial , Humanos , Hidroxicloroquina/efeitos adversos , Assistência de Longa Duração , Lúpus Eritematoso Sistêmico/induzido quimicamente , Lúpus Eritematoso Sistêmico/diagnóstico , Doenças por Armazenamento dos Lisossomos/induzido quimicamente , Doenças por Armazenamento dos Lisossomos/diagnóstico , Masculino , Pessoa de Meia-Idade , Músculos/patologia , Doenças Musculares/patologia , Redução de Peso/efeitos dos fármacosRESUMO
INTRODUCTION: This is a clinical case illustrating a diagnosis of an IgG4 related-disease (IgG4-RD) diagnosed in a vascular context. CASE REPORT: A 47-year-old man with no past medical history consulted for a recent and disabling Raynaud phenomenon without trophic disorder. Vascular examinations revealed multiple arterial thromboses with no abnormal finger and toe pressures. Secondly, weight loss and submandibular glands enlargement appeared, leading to the diagnosis of IgG4-RD without a link being able to be established with vascular involvement. This is the second observation of this association. A French translation of the new classification criteria for IgG4-RD published in 2019 by the American College of Rheumatology and European Ligue Against Rhumatism (ACR/EULAR) is offered with direct application to the clinical case. CONCLUSION: A Raynaud phenomenon with distal arterial thrombosis is rarely observed in the IgG4-RD.