Case Studies

 Case 10.14 Polymyositis

A 32-year-old woman with a past history of ulcerative colitis (quiescent for the last 7 years), presented with a dry cough. The cough became productive of clear sputum and she was admitted 2 months later with increasing dyspnoea, myalgia and arthralgia. A clinical diagnosis of fibrosing alveolitis was made and confirmed by transbronchial biopsy. She was treated with prednisolone, which improved her arthralgia, and it became clear that she had a severe proximal myopathy. Serum creatine kinase was found to be very high and a muscle biopsy showed necrosis and a cellular infiltrate compatible with polymyositis. She had a circulating autoantibody to Jo1 antigen (see Chapter 19).

She recovered eventually, after a stormy course which included treatment with pulsed methylprednisolone, oral azathioprine and three plasma exchanges of 2.5 litres. She has persistent myalgia and some arthralgia and remains on 20mg prednisolone daily.