Muscle Weakness in a Patient with History of Poliomyelitis: A Differential Diagnosis for Post-polio Syndrome (PPS) and Dermatomyositis

Sang Hee An; Ha Young Na; Seong Hui Kang; Soo Youn Park; Hyung Min Yu; Chae Ho Lee; Ji Wan Kim; Se Woong Kwon; Junghwa Lee; Hae-Rim Kim; Sang-Heon Lee

doi:10.4078/jrd.2014.21.3.147

Journal List > J Rheum Dis > v.21(3) > 1064109

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

An, Na, Kang, Park, Yu, Lee, Kim, Kwon, Lee, Kim, and Lee: Muscle Weakness in a Patient with History of Poliomyelitis: A Differential Diagnosis for Post-polio Syndrome (PPS) and Dermatomyositis

Case Report

J Rheum Dis 2014;21(3):147-150.

Published online: 31 October 2014

DOI: https://doi.org/10.4078/jrd.2014.21.3.147

Muscle Weakness in a Patient with History of Poliomyelitis: A Differential Diagnosis for Post-polio Syndrome (PPS) and Dermatomyositis

Sang Hee An, Ha Young Na, Seong Hui Kang, Soo Youn Park, Hyung Min Yu, Chae Ho Lee, Ji Wan Kim, Se Woong Kwon, Junghwa Lee, Hae-Rim Kim, Sang-Heon Lee

Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea

Corresponding to: Sang-Heon Lee, Department of Internal Medicine, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 143-729, Korea. E-mail: shlee@kuh.ac.kr

Received 27 March 2013 Revised 25 June 2013 Accepted 26 June 2013

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Dermatomyositis (DM) is an idiopathic inflammatory myopathy, characterized by inflammation of the proximal skeletal muscles and typical skin manifestations, which results in symmetric muscle weakness. A 43-year-old man was presented with skin rash and left leg weakness, and he had a history of poliomyelitis. Initially, he was diagnosed as having post-polio syndrome (PPS) due to unilateral muscle weakness and a result of an the electromyography (EMG), which had shown patterns of PPS. After 4 months with conservative therapy for PPS, weakness of bilateral upper arms had developed and skin rashes on his entire body had aggravated and progressed. He was diagnosed as having dermatomyositis, based on elevated muscle enzyme levels, typical skin rashes, and typical EMG findings, which indicated muscle disease. When a patient with previous poliomyelitis has a newly developed muscle weakness or pain, we should consider various possible causes other than PPS.

Keywords: Dermatomyositis, Post-polio syndrome, Poliomyelitis, Skin rash, Muscle weakness

REFERENCES

1. Zong M, Lundberg IE. Pathogenesis, classification and treatment of inflammatory myopathies. Nat Rev Rheumatol. 2017; 297–306.

2. Chung JH, Seo PG. Clinical manifestations of dermatomyositis. Korean J Dermatol. 2002; 40:258–65.

3. Bohan A, Peter JB. Polymyositis and dermatomyositis (second of two parts). N Engl J Med. 1975; 292:403–7.

4. Gonzalez H, Olsson T, Borg K. Management of postpolio syndrome. Lancet Neurol. 2010; 9:634–42.

5. Miller FW. Polymyositis and dermatomyositis. Goldman L, Andrew IS, editors. Goldman's Cecil medicine. 24th ed.p. 1716–20. Philadelphia: Saunders Elsevier;2012.

6. Trojan DA, Cashman NR. Post-poliomyelitis syndrome. Muscle Nerve. 2005; 31:6–19.

7. Jubelt B, Agre JC. Characteristics and management of postpolio syndrome. JAMA. 2000; 284:412–4.

8. Dalakas MC. Polymyositis, dermatomyositis and in-clusion-body myositis. N Engl J Med. 1991; 325:1487–98.

9. Dalakas MC, Hohlfeld R. Polymyositis and dermatomyositis. Lancet. 2003; 362:971–82.

10. Barkhaus PE, Nandedkar SD, Sanders DB. Quantitative EMG in inflammatory myopathy. Muscle Nerve. 1990; 13:247–53.

11. Parissis D, Karkavelas G, Taskos N, Milonas I. Inclusion body myositis in a patient with a presumed diagnosis of postpolio syndrome. J Neurol. 2003; 250:619–21.

Figure 1.

Skin lesions show (A) erythema and edema in both upper eyelids (Heliotrope rash), and (B) raised violaceous rashes or papules in dorsal surfaces of metacarpophalangeal and interphalangeal joints (Gottron's papules).

Figure 2.

(A) Axial T2-weighted spin-echo MR image shows edema in the left thigh musculature, prominently in the semitendinous muscle (short arrow) and gluteus maximus (long arrow). (B) Axial T1-weighted spin-echo contrast MR image shows diffuse enhancement in the left semitendinous muscle and gluteus maximus with deep fascia enhancement.

Figure 3.

Muscle biopsy shows that focal atrophic myofibers (short arrow) and some necrotic myofibers (long arrow) associated with some regenerating myofibers present on perivascular area (×400).

TOOLS

Similar articles