Nagafuchi Hiroko, Nakano Hiromasa, Ooka Seido, Takakuwa Yukiko, Yamada Hidehiro, Tadokoro Mamoru, Shimojo Sadatomo, Ozaki Shoichi
Division of Rheumatology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan.
Intern Med. 2016;55(22):3369-3374. doi: 10.2169/internalmedicine.55.7172. Epub 2016 Nov 15.
This report describes a rare case of recurrent bilateral focal myositis and its successful treatment via methotrexate. A 38-year-old man presented myalgia of the right gastrocnemius in May 2005. Magnetic resonance imaging showed very high signal intensity in the right gastrocnemius on short-tau inversion recovery images. A muscle biopsy revealed inflammatory CD4+ cell-dominant myogenic change. Focal myositis was diagnosed. The first steroid treatment was effective. Tapering of prednisolone, however, repeatedly induced myositis relapse, which progressed to multiple muscle lesions of both lower limbs. Initiation of methotrexate finally allowed successful tapering of prednisolone, with no relapse in the past 4 years.
本报告描述了一例罕见的复发性双侧局灶性肌炎病例及其通过甲氨蝶呤成功治疗的过程。一名38岁男性于2005年5月出现右腓肠肌肌痛。磁共振成像显示在短反转时间反转恢复序列图像上右腓肠肌信号强度极高。肌肉活检显示以炎症性CD4 + 细胞为主的肌源性改变。诊断为局灶性肌炎。首次使用类固醇治疗有效。然而，泼尼松龙逐渐减量时反复诱发肌炎复发，并进展为双下肢多处肌肉病变。开始使用甲氨蝶呤最终成功使泼尼松龙减量，在过去4年中未复发。
