Enoki T, Nakagami T, Murakami A, Okisaka S, Nakabayasi I, Yoshizawa N
Department of Ophthalmology, National Defense Medical College, Saitama-ken, Japan.
Nippon Ganka Gakkai Zasshi. 1997 May;101(5):441-5.
Sight threatening ocular complications are rare in adult patients with dermatomyositis. We encountered a 52-year-old female with dermatomyositis who had severe visual disturbance and rapidly progressive intersitial pneumonia. She was admitted to our hospital because of skin erythema, general fatigue, mild fever, and severe bilateral visual disturbance. Rentinal hemorrhages, cotton wool spots, and macular edema were observed in her fundus at the first ophthalmic examination. A diagnosis of dermatomyositis was made because of the myogenic pattern of her electromyogram, elevation of serum creatine kinase, and skin lesions. Oral prednisolone treatment was started and the retinopathy was improved, but was complicated by acute interstitial pneumonia. The interstitial pneumonia was not respond to steroid pulse therapy with methylprednisolone, and the patient died of respiratory failure on the 47th day after the onset of visual symptoms. In adult dermatomyositis patients, the complication of severe retinopathy should be considered as a risk factor for rapid progress of interstitial pneumonia.
在成年皮肌炎患者中，威胁视力的眼部并发症较为罕见。我们遇到一名52岁患有皮肌炎的女性，她有严重的视力障碍和快速进展的间质性肺炎。她因皮肤红斑、全身乏力、低热以及严重的双侧视力障碍入住我院。首次眼科检查时，在她的眼底观察到视网膜出血、棉絮斑和黄斑水肿。由于其肌电图呈肌源性模式、血清肌酸激酶升高以及皮肤病变，诊断为皮肌炎。开始口服泼尼松龙治疗，视网膜病变有所改善，但并发了急性间质性肺炎。间质性肺炎对甲泼尼龙的类固醇脉冲疗法无反应，患者在出现视力症状后的第47天死于呼吸衰竭。在成年皮肌炎患者中，严重视网膜病变的并发症应被视为间质性肺炎快速进展的一个危险因素。
