Refractory dermatomyositis in a young female

Mădălina-Pușa Roșu⁽¹⁾, Georgiana-Patricia Ogrutan⁽¹⁾, Laura Popa⁽²⁾, Anca Evsei⁽³⁾, Mihai-Alexandru Preda⁽⁴⁾, Denisa Predețeanu⁽¹⁾

1)Department of Internal Medicine and Rheumatology, "Sf. Maria" Clinical Hospital, Bucharest, Romania
2)Department of Anesthesiology and Intensive Care, "Sf. Maria" Clinical Hospital, Bucharest, Romania
3)Department of Pathology, "Sf. Maria" Clinical Hospital, Bucharest, Romania
4)ENT Department, "Sf. Maria" Clinical Hospital, Bucharest, Romania

Background: Dermatomyositis is an idiopathic autoimmune connective tissue disease. It is typically characterized by proximal muscle weakness and skin rashes, but is known to have a spectrum of cutaneous and muscle involvement.
Methods: We present the case of a 37-year-old female, smoker, with breast implants in 2019, with no other significant medical history, who presented for important pain and muscle weakness with functional impairment. Taking into consideration the clinical presentation (characteristic skin rash, proximal and symmetrical muscle weakness), the serological tests (positivity of anti-Mi-2 antibody), the suggestive electromyographic aspect, the diagnosis of dermatomyiositis was established.
Results: The present case illustrates a refractory dermatomyositis with highly increased muscle enzymes.The patient required multiple treatment regimens including high dose glucocorticoids, methotrexate, azathioprine, mycophenolate mofetil without significant clinical improvement. Thus, the intravenous imunoglobulines therapy was initiated which achieved control of both clinical and biological features of the disease activity.
Conclusion: Treatments for refractory dermatomyositis requires effective immunosupressive therapy. The selection of specific agents depends on patient’s disease activity, comorbidities, and tolerance. Thus, severe refractory idiopathic inflammatory myopathy represents a challenge for the clinician.

Keywords: dermatomyositis, anti-Mi-2 antibody, methotrexate, mycophenolate mofetil

Corresponding author(s): Madalina-Pusa Rosu, Department of Internal Medicine and Rheumatology, "Sf. Maria" Clinical Hospital, Bucharest, Romania, Bulevardul Ion Mihalache 37-39, Bucharest, Romania; e-mail: madalina.duna@yahoo.com