Iguchi H, Kishi M, Fujioka T, Wakata N, Kinoshita M
Fourth Department of Internal Medicine, Toho University.
Rinsho Shinkeigaku. 1996 Jan;36(1):22-4.
We reported a case of polymyositis manifested after beta-interferon therapy for chronic viral hepatitis type C. In November 1992, a 62-year-old female was diagnosed as having chronic viral hepatitis type C. In January 1993, she was treated with beta-interferon(total 2.52 x 10(8)IU). In March 1993, after the treatment, she noticed weakness and atrophy of her lower extremities. Neurological examination revealed proximal dominant muscle weakness and atrophy of the extremities. Increased levels of serum CK and aldolase were disclosed on admission. By needle EMG, a low voltage with short duration interference pattern was noted. February 7, by muscle biopsy of the right quadriceps, necrotic myofibers, marked variation in fiber diameter, stromal mononuclear cell infiltration, and endomysial fibrosis was detected. The immunological stain of infiltrating cells in the muscle fibers revealed CD4:CD8 ratio as 64:55, whereas in conventional polymyositis CD8 cells dominate CD4 cells. Diagnosis of polymyositis was made and oral prednisolone 60 mg a day was started. Her symptoms and signs improved gradually and she was discharged after 2 months. Many adverse effects due to immunological disturbances caused by interferon treatment have been reported, but polymyositis due to interferon has been very rare. When interferon will be prescribed, manifestation of polymyositis should be considered.
我们报告了1例在使用β干扰素治疗慢性丙型病毒性肝炎后出现的多发性肌炎病例。1992年11月，一名62岁女性被诊断为慢性丙型病毒性肝炎。1993年1月，她接受了β干扰素治疗（总量为2.52×10⁸IU）。1993年3月，治疗后她注意到下肢无力和萎缩。神经学检查显示近端为主的肌肉无力和四肢萎缩。入院时发现血清肌酸激酶（CK）和醛缩酶水平升高。通过针电极肌电图检查，发现有低电压、短时限的干扰图形。2月7日，通过对右股四头肌进行肌肉活检，检测到坏死的肌纤维、纤维直径明显变异性、间质单核细胞浸润和肌内膜纤维化。对肌纤维中浸润细胞的免疫染色显示CD4:CD8比例为64:55，而在传统的多发性肌炎中CD8细胞占主导地位。诊断为多发性肌炎，并开始每天口服泼尼松龙60mg。她的症状和体征逐渐改善，2个月后出院。已有许多关于干扰素治疗引起免疫紊乱导致的不良反应的报道，但由干扰素引起的多发性肌炎非常罕见。当开具干扰素处方时，应考虑到多发性肌炎的表现。
