Dermatomyositis: A Rare Extra-intestinal Manifestation of Ulcerative Colitis

Chang Hyun Park; Na Hye Myong; Hyun Don Joo; Mi Il Kang

doi:10.4078/jrd.2016.23.3.183

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Park, Myong, Joo, and Kang: Dermatomyositis: A Rare Extra-intestinal Manifestation of Ulcerative Colitis

Case Report

J Rheum Dis 2016;23(3):183-186.

Published online: 31 October 2016

DOI: https://doi.org/10.4078/jrd.2016.23.3.183

Dermatomyositis: A Rare Extra-intestinal Manifestation of Ulcerative Colitis

Chang Hyun Park¹, Na Hye Myong², Hyun Don Joo¹, Mi Il Kang¹

¹Department of Internal Medicine, Dankook University Medical College, Cheonan, Korea

²Department of Pathology, Dankook University Medical College, Cheonan, Korea

Corresponding to: Mi Il Kang, Department of Internal Medicine, Dankook University Medical College, 119 Dandae-ro, Dongnam-gu, Cheonan 31116, Korea. E-mail: satisfe00@naver.com

Received 22 July 201517 August 2015 Accepted 24 August 2015

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

Inflammatory myositis as an extra-intestinal manifestation of inflammatory bowel disease (IBD) is rare. Coexistence of im-muno-mediated diseases in patients with IBD and myositis suggests a common etiopathogenic mechanism underlying these conditions. The current report refers to a rare case of a 45-year-old Korean female with ulcerative colitis (UC) who developed dermatomyositis. She presented with skin rash and proximal muscle weakness, and her disease activity of UC was in remission state. Electromyography, magnetic resonance imaging, and deltoid muscle biopsy were performed. She was diagnosed with dermatomyositis associated with UC and treatment with glucocorticoids and azathioprine resulted in improvement in muscle power and skin rash. Clinicians should be aware of this unusual extra-intestinal manifestation.

Keywords: Inflammatory bowel diseases, Ulcerative colitis, Myositis, Polymyositis

REFERENCES

1. Bernstein CN, Blanchard JF, Rawsthorne P, Yu N. The prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study. Am J Gastroenterol. 2001; 96:1116–22.

2. Orchard TR, Wordsworth BP, Jewell DP. Peripheral arthropathies in inflammatory bowel disease: their articular distribution and natural history. Gut. 1998; 42:387–91.

3. Paoluzi OA, Crispino P, Rivera M, Iacopini F, Palladini D, Consolazio A, et al. Skeletal muscle disorders associated with inflammatory bowel diseases: occurrence of myositis in a patient with ulcerative colitis and Hashimoto's thyroi-ditis− case report and review of the literature. Int J Colorectal Dis. 2006; 21:473–7.

4. Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts). N Engl J Med. 1975; 292:344–7.

5. Oshitani H, Wakabayashi Y, Sawaguchi Y, Koike H, Yoshino Y. A case of dermatomyositis followed by multiple mononeuritis, with the history of ulcerative colitis and Basedow's disease. J Kyorin Med Soc. 1981; 12:47–53.

6. Hayashi T, Nakamura T, Kurachi K, Asai Y, Nakajima A, Suzuki S, et al. Ulcerative colitis accompanied with sarcoidosis and dermatomyositis: report of a case. Dis Colon Rectum. 2008; 51:474–6.

7. Leibowitz G, Eliakim R, Amir G, Rachmilewitz D. Dermatomyositis associated with Crohn's disease. J Clin Gastroenterol. 1994; 18:48–52.

8. Hodgson HJ, Potter BJ, Jewell DP. Immune complexes in ulcerative colitis and Crohn's disease. Clin Exp Immunol. 1977; 29:187–96.

9. Braun-Moscovici Y, Schapira D, Balbir-Gurman A, Nahir AM. Inflammatory bowel disease and myositis. Clin Rheumatol. 1999; 18:261–3.

10. Shimoyama T, Tamura Y, Sakamoto T, Inoue K. Immunemediated myositis in Crohn's disease. Muscle Nerve. 2009; 39:101–5.

11. Hayashi K, Kurisu Y, Ohshiba S, Kawamura H, Furutama D, Takada K, et al. Report of a case of Crohn's disease associated with hyper-creatine phosphokinase-emia. Jpn J Med. 1991; 30:441–5.

12. Danieli MG, Malcangi G, Palmieri C, Logullo F, Salvi A, Piani M, et al. Cyclosporin A and intravenous immunoglobulin treatment in polymyositis/dermatomyositis. Ann Rheum Dis. 2002; 61:37–41.

13. Metzger AL, Bohan A, Goldberg LS, Bluestone R, Pearson CM. Polymyositis and dermatomyositis: combined methotrexate and corticosteroid therapy. Ann Intern Med. 1974; 81:182–9.

14. Podolsky DK. Inflammatory bowel disease. N Engl J Med. 2002; 347:417–29.

Figure 1.

(A) Axial T2 weighted image with fat saturation showed bilateral symmetrical diffuse increased signal intensity in both obturator internus muscles (arrows). (B) Axial T2 weighted image with fat saturation showed epimysial accentuation of both vastus muscles with diffuse interstitial edema in the subcutaneous fat layer on both thighs.

Figure 2.

Biopsy from the left deltoid muscle revealed a size variation of myofibers and multifocal lymphocyte infiltration in the perimyseal area and perivascular area. Some degenerating and regenerating myofibers are shown. There is no evidence of vasculitis (H&E, ×100).

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