Rajalingham Sakthiswary, Said Mohd Shahrir Mohd, Shaharir Syahrul Sazliyana, AbAziz Aini, Periyasamy Petrick, Anshar Fauzi Md
Department of Medicine, National University of Malaysia, Malaysia.
BMJ Case Rep. 2011 Oct 28;2011:bcr0820114675. doi: 10.1136/bcr.08.2011.4675.
Dermatomyositis is a rare rheumatic disease which predominantly affects the muscles and skin requiring a protracted course of immunosuppressants which may predispose the patients to opportunistic infections. A 49-year-old lady was diagnosed to have dermatomyositis in August 2010 based on history, significantly raised creatine kinase level and muscle biopsy findings. She had recurrent admissions due to fever, myalgia and muscle weakness. She had spiking temperature despite high dose steroids, broad-spectrum antibiotics and antifungal agents. This prompted extensive investigation which leads us to the additional diagnosis of disseminated tuberculosis involving the lungs, muscles and bones. This case demonstrates the challenge in controlling the disease activity of dermatomyositis with immunosuppressants in the setting of disseminated tuberculosis.
皮肌炎是一种罕见的风湿性疾病，主要影响肌肉和皮肤，需要长期使用免疫抑制剂治疗，而这可能使患者易患机会性感染。一名49岁女性于2010年8月根据病史、显著升高的肌酸激酶水平和肌肉活检结果被诊断为皮肌炎。她因发热、肌痛和肌无力反复入院。尽管使用了大剂量类固醇、广谱抗生素和抗真菌药物，她仍有高热。这促使进行了广泛的检查，最终我们额外诊断出她患有播散性结核病，累及肺部、肌肉和骨骼。该病例表明，在播散性结核病的情况下，使用免疫抑制剂控制皮肌炎的疾病活动具有挑战性。
