Suwa A, Hirakata M, Tsuzaka K, Hama N, Fujii T, Mimori T, Akizuki M
Department of Medicine, Keio University, School of Medicine, Tokyo.
Ryumachi. 1992 Feb;32(1):73-9.
A case of dermatomyositis which developed one month after normal delivery and subsided spontaneously was reported. A 29-year-old woman gave birth to a healthy child. One month later, she noticed muscular pain and weakness of the upper extremities. On admission, there were diffuse edema of upper eyelids with heliotrope rash. The reddish skin rashes were observed on the extensor surfaces of the PIP and MP joints of fingers. Erythrocyte sedimentation rate was 29 mm/hr. The lactic dehydrogenase (LDH), SGOT, CK levels were 470 (normal 150 to 320 IU/l), 43 (normal 6 to 25 IU/l) and 317 (normal 21 to 110 IU/l) respectively. Autoantibodies to nuclear and cytoplasmic antigens were negative. Rheumatoid factor and anti-DNA antibody were negative. Thyroid function was normal. An electromyogram (EMG) demonstrated small amplitude short-duration polyphasic motor unit potentials. The muscle biopsy specimen from left upper arm showed degenerating muscle fibers and infiltration of inflammatory cells surrounding blood vessels. The skin biopsy revealed the presence of edema and perivascular infiltration of lymphocytes. Based on these clinical features and results of various diagnostic tests, a diagnosis of dermatomyositis was established. After the admission, muscle strength has improved dramatically and the CK returned to normal level without specific drug therapy. She has since been seen as an out patient, and complete remission lasted for two years up to date. Review of the literature disclosed that 13 cases of PM/DM which developed during pregnancy or postpartum have been reported including the present case. Detailed analysis showed that these patients were characterized by mild muscular diseases, rare occurrence of internal organ involvements and good response to steroid therapy. As our case, a spontaneous remission was also observed. Although the mechanism involved in occurrence of inflammatory myositis associated with pregnancy or delivery are not clarified, these patient indicated a presence of subset of PM/DM which do not require intensive drug therapy.
报告了一例在正常分娩后一个月发病并自发消退的皮肌炎病例。一名29岁女性分娩出一个健康的婴儿。一个月后，她注意到上肢肌肉疼痛和无力。入院时，上眼睑有弥漫性水肿伴紫罗兰色皮疹。在手指近端指间关节和掌指关节的伸侧观察到红色皮疹。红细胞沉降率为29mm/小时。乳酸脱氢酶（LDH）、谷草转氨酶（SGOT）、肌酸激酶（CK）水平分别为470（正常150至320IU/L）、43（正常6至25IU/L）和317（正常21至110IU/L）。针对核抗原和胞质抗原的自身抗体均为阴性。类风湿因子和抗DNA抗体均为阴性。甲状腺功能正常。肌电图（EMG）显示运动单位电位波幅小、时限短且多相。左上臂的肌肉活检标本显示肌纤维退变以及血管周围有炎性细胞浸润。皮肤活检显示有水肿和淋巴细胞血管周围浸润。基于这些临床特征和各种诊断性检查结果，确诊为皮肌炎。入院后，未进行特殊药物治疗，肌肉力量显著改善，CK恢复至正常水平。此后她作为门诊患者接受随访，至今完全缓解已持续两年。文献回顾显示，包括本病例在内，已有13例在妊娠或产后发生的皮肌炎/多肌炎病例报告。详细分析表明，这些患者的特点是肌肉疾病较轻、很少累及内脏器官且对类固醇治疗反应良好。如同我们的病例，也观察到了自发缓解。虽然与妊娠或分娩相关的炎性肌炎发生机制尚不清楚，但这些患者提示存在一类不需要强化药物治疗的皮肌炎/多肌炎亚组。
