Shimoyama Takashi, Tamura Yohei, Sakamoto Tsuyoshi, Inoue Kiyoharu
Department of Neurology, Jikei University School of Medicine, Tokyo, Japan.
Muscle Nerve. 2009 Jan;39(1):101-5. doi: 10.1002/mus.21164.
We report a patient with uncontrolled Crohn's disease who presented with progressive weakness of proximal muscles and a marked elevation of serum creatine kinase. Muscle biopsy from the left deltoid exhibited myositic changes with inflammatory infiltrates in the perimysium, endomysium, and perivascular locations. Most were stained as CD68-positive macrophages, whereas some were CD4- and CD8-positive T lymphocytes. Due to uncontrolled bowel inflammation, several fistulae were found in the descending colon, and partial colectomy was performed. An examination of the resected colon exhibited inflammation of the bowel structure surrounded mainly by CD68-positive macrophages. The histopathological findings of the descending colon were analogous to those of the muscle. After an increased dose of mesalazine and partial colectomy, her muscle symptoms improved. These findings suggest that the myositis in Crohn's disease is immune-mediated and that treatment of bowel inflammation should be emphasized as opposed to steroid or other immunosuppressive therapy.
我们报告了一名患有未控制的克罗恩病的患者，该患者出现近端肌肉进行性无力以及血清肌酸激酶显著升高。左侧三角肌的肌肉活检显示有肌炎改变，在肌束膜、肌内膜和血管周围有炎性浸润。大多数被染成CD68阳性巨噬细胞，而一些是CD4和CD8阳性T淋巴细胞。由于肠道炎症未得到控制，在降结肠发现了几个瘘管，并进行了部分结肠切除术。对切除的结肠进行检查显示，肠结构的炎症主要被CD68阳性巨噬细胞包围。降结肠的组织病理学发现与肌肉的相似。在增加美沙拉嗪剂量并进行部分结肠切除术后，她的肌肉症状有所改善。这些发现表明，克罗恩病中的肌炎是免疫介导的，与类固醇或其他免疫抑制治疗相反，应强调肠道炎症的治疗。
