Internal Medicine Department, Centro Hospitalar Universitário de São João, Oporto, Portugal.
Intensive Care Medicine Department, Centro Hospitalar Universitário de São João, Oporto, Portugal.
Int J Rheum Dis. 2023 Dec;26(12):2576-2580. doi: 10.1111/1756-185X.14757. Epub 2023 May 27.
Immune-mediated diseases tend to overlap in ways that are not completely understood. When a presentation is not entirely explained by a former condition, other hypotheses should arise. Additionally, the activity of 2 overlapping immune-mediated conditions is not always associated. We present an unusual association between Crohn's disease and dermatomyositis in a 28-year-old man. The patient presented with a 2-month history of proximal muscle weakness and a skin rash with heliotrope periorbital edema. Since the patient had already been diagnosed with Crohn's disease, he was under immunosuppressive therapy, and he had a family history of psoriasis, the diagnosis was not immediate and required an integrative approach. Laboratory analysis revealed elevated creatine kinase, aldolase, lactic dehydrogenase and transaminase levels. He had no symptoms of Crohn's disease exacerbation. Magnetic resonance imaging, electromyography, and muscle biopsy findings were consistent with inflammatory myopathy, although non-specific. Corticosteroids were initiated with clinical and laboratory improvement within 1 month.
免疫介导性疾病往往以尚未完全了解的方式重叠。当一种表现不能完全用以前的疾病来解释时，就应该出现其他假设。此外，两种重叠的免疫介导性疾病的活动并不总是相关的。我们报告了一例 28 岁男性克罗恩病和皮肌炎之间不常见的关联。该患者出现近端肌无力和皮疹，表现为眶周水肿伴向阳疹。由于患者已被诊断为克罗恩病，正在接受免疫抑制治疗，且有银屑病家族史，因此诊断并不立即，需要综合方法。实验室分析显示肌酸激酶、醛缩酶、乳酸脱氢酶和转氨酶水平升高。他没有克罗恩病恶化的症状。磁共振成像、肌电图和肌肉活检结果与炎症性肌病一致，但不具有特异性。皮质类固醇治疗后 1 个月内临床和实验室改善。
