Successful treatment with tacrolimus of progressive interstitial pneumonia associated with amyopathic dermatomyositis refractory to cyclosporine
Successful treatment with tacrolimus of progressive interstitial pneumonia associated with amyopathic dermatomyositis refractory to cyclosporine
复制标题
DOI：
10.1007/s10067-009-1358-x
复制
发表时间：
2010-04-01
影响因子：
3.4
通讯作者：
Kumamoto, Toshihide
中科院分区：
文献类型：
--
作者：
Ando, Masaru;Miyazaki, Eishi;Kumamoto, Toshihide
患者男，58岁，因甲襞周围及手足背侧关节处出现红斑、皮疹而入院，无肌无力。因此，他被诊断为无肌性皮肌炎。他有中度低氧血症，胸部计算机断层扫描显示双侧毛玻璃样阴影，提示并发间质性肺炎。治疗开始与脉冲甲基强的松龙，其次是高剂量皮质类固醇，脉冲环磷酰胺，环孢素。皮肤表现改善;然而，在2个月的治疗期间，肺浸润和低氧血症恶化。由于对治疗的临床反应不足，将治疗从环孢素转换为他克莫司，这导致间质性肺炎消退。该病例表明，当判断为环孢素难治性时，应考虑对患有这种危及生命的疾病的患者使用他克莫司。
A 58-year-old male was admitted to our hospital because of periungual nailfold an erythema and erythematous rash on the dorsal joints of his hands and feet, but no muscle weakness. He was thus diagnosed to have amyopathic dermatomyositis. He had moderate hypoxemia and his chest computed tomography scans demonstrated bilateral ground-glass opacities, implicating complication with interstitial pneumonia. Therapy was initiated with pulsed methylprednisolone followed by high-dose corticosteroids, pulsed cyclophosphamide, and cyclosporine. The skin manifestations improved; however, the pulmonary infiltrates and hypoxemia deteriorated during the 2-month period of the treatment. The treatment was switched from cyclosporine to tacrolimus because of an inadequate clinical response to the therapy, and this resulted in the resolution of interstitial pneumonia. This case indicates that tacrolimus administration should be considered for patients with this life-threatening disorder when it is judged to be refractory to cyclosporine.