Severe Respiratory Failure in the Coexistence of Polymyositis and Hypothyroidism: A Case Report

Year 2013, Volume: 38 Issue: 4, 744 - 750, 01.12.2013

Fatih Yıldız , Didem Arslan Taş Ezgi Özyılmaz Mehtap Evran Emre Karakoç Suzan Zorludemir Eren Erken

Abstract

Polymyositis is a systemic, inflammatory muscle disease. Respiratory insufficiency as a result of respiratory muscle involvement could also be observed. Here we report a fortyone-year-old man who attended to the hospital with the complaints of shortness of breath and chest pain that have suddenly started. Physical examination has revealed proximal muscle weakness. Serum creatinine phosphokinase level has increased, ANA was positive and the electromyographic examination has revealed myopathic changes. Deltoid muscle biopsy was in accordance with polymyositis. Methyl-prednisolone 1 gram iv pulse therapy was given during the first 5 days. He was started with 25 mg/week parenteral methotrexate. Laboratory tests suggested hypothyroidism and levothyroxine replacement therapy was started. The clinical findings have improved concomitant with the reduction in the muscle enzymes and thyroid stimulant hormone levels into the normal ranges. He was discharged with the recommendation of the NIMV device application during night-time. The clinical symptoms are more severe in the presence of alveolar hypoventilation due to polymyositis and coincidantal hypothyroidism.

Keywords

Alveolar hypoventilation, non invasive mechanical ventilation, hypothyroidism, polymyositis

Şiddetli solunum yetmezliğine neden olan polimiyozit ve hipotiroidi birlikteliği : Olgu sunumu

Abstract

Polimyozit sistemik inflamatuar bir kas hastalığıdır. Solunum kas tutulumuna bağlı solunum yetmezliği görülebilen bir klinik tablodur. Burada 41 yaşında hastanemize ani başlayan nefes darlığı ve göğüs ağrısı şikayetleriyle başvuran bir hasta sunulmuştur. Muayenesinde proksimal kas güçsüzlüğü saptandı. Kreatin fosfokinaz yüksekliği, ANA pozitifliği ve elektromyografik incelemesinde myopatik değişiklikler bulundu. Deltoid kas biyopsisi sonucu polimyozit ile uyumlu bulundu. Hastaya 5 gün 1 gram iv pulse metil prednizolon tedavisi uygulandı. Aynı zamanda 25 mg/hafta parenteral metotreksat tedavisi uygulandı. Laboratuar testinde hipotiroidi de tespit edilmesi üzerine levotiroksin replasmanı tedaviye eklendi. Takipte klinik bulgular ile birlikte kas enzimleri ve tiroid stimülan hormon düzeyleri düzelen hasta gece NIMV kullanımı önerisi ile taburcu edildi. Polimyozite hipotiroidinin eşlik ettiği tabloda klinik semptomlar daha ciddi izlenmektedir.

Keywords

Alveolar hipoventilasyon, invaziv olmayan mekanik ventilasyon, hipotiroidi, polimiyozit

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• Yazışma Adresi / Address for Correspondence: Dr. Fatih Yıldız, Cukurova University Faculty of Medicine, Department of Rheumatology-Immunology Balcalı Hospital, Sarıçam, 01330 ADANA
• E mail: [e-mail] geliş tarihi/received :12.02.2013 kabul tarihi/accepted:01.04.2013