Nuri Koko, Kotani Takuya, Takeuchi Tohru, Shoda Takeshi, Makino Shigeki, Hanafusa Toshiaki
Nihon Kokyuki Gakkai Zasshi. 2010 Jun;48(6):444-8.
A 67-year-old woman was admitted to our hospital because of erythema in the eyelids and fingers of both hands. Slight muscle weakness in the proximal limbs, a heliotrope rash, Gottron's sign, and mechanic's hand were observed. Creatine kinase serum levels were slightly elevated (376U/l), and the patient tested negative for all autoantibodies except for the antinuclear antibody. Chest computed tomography showed interstitial pneumonia (IP). Based on these findings, the patient was given a diagnosis of dermatomyositis (DM) associated with IP. Combined prednisolone (1 mg/kg/day) and cyclosporin-A (Cy-A 4 mg/kg/day) therapy was initiated; the patient showed marked improvement, but the Cy-A caused liver damage. Therefore, Cy-A was tapered off, and tacrolimus was simultaneously started, initially at a dose of 1 mg/day, building up to a sustained dose of 4 mg/day. The patient's IP and liver condition improved. Tacrolimus is a useful drug for the treatment of DM-IP in cases where Cy-A causes intolerable adverse reactions.
一名67岁女性因双眼睑及双手手指红斑入院。观察到近端肢体轻度肌无力、向阳疹、Gottron征和技工手。血清肌酸激酶水平轻度升高（376U/l），除抗核抗体外，患者所有自身抗体检测均为阴性。胸部计算机断层扫描显示间质性肺炎（IP）。基于这些发现，患者被诊断为与IP相关的皮肌炎（DM）。开始联合泼尼松龙（1mg/kg/天）和环孢素A（Cy - A 4mg/kg/天）治疗；患者病情明显改善，但Cy - A导致肝损伤。因此，逐渐减少Cy - A用量，同时开始使用他克莫司，初始剂量为1mg/天，逐渐增至维持剂量4mg/天。患者的IP和肝脏状况得到改善。在Cy - A引起无法耐受的不良反应的情况下，他克莫司是治疗DM - IP的有用药物。
