Successful Treatment of Anti-MDA5 Antibody-Positive Dermatomyositis-Associated Rapidly Progressive-Interstitial Lung Disease by Plasma Exchange: Two Case Reports
Background: Patients with anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis (DM) are frequently accompanied by rapidly progressive-interstitial lung disease (RP-ILD). They are often refractory to intensive immunosuppressive therapy and have poor prognosis. Case...
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doaj-86267068bdef429091a3f0db5b631dc22021-07-28T02:33:29ZengSAGE PublishingClinical Medicine Insights: Case Reports1179-54762021-07-011410.1177/11795476211036322Successful Treatment of Anti-MDA5 Antibody-Positive Dermatomyositis-Associated Rapidly Progressive-Interstitial Lung Disease by Plasma Exchange: Two Case ReportsRina Takahashi0Tadashi Yoshida1Kohkichi Morimoto2Yasushi Kondo3Jun Kikuchi4Shuntaro Saito5Sho Ishigaki6Yuko Kaneko7Tsutomu Takeuchi8Hiroshi Itoh9Mototsugu Oya10Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, JapanApheresis and Dialysis Center, Keio University School of Medicine, Shinjuku-ku, Tokyo, JapanApheresis and Dialysis Center, Keio University School of Medicine, Shinjuku-ku, Tokyo, JapanDivision of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, JapanDivision of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, JapanDivision of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, JapanDivision of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, JapanDivision of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, JapanDivision of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, JapanDivision of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, JapanDepartment of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, JapanBackground: Patients with anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis (DM) are frequently accompanied by rapidly progressive-interstitial lung disease (RP-ILD). They are often refractory to intensive immunosuppressive therapy and have poor prognosis. Case presentation: A 73-year-old woman presented with fever, cold symptoms, and skin eruption for a month. She also exhibited muscle weakness on upper extremities slightly. The titer of anti-MDA5 antibody was extremely high, and computed tomography showed ground glass opacity and reticular shadows in the lungs. She was diagnosed as anti-MDA5 antibody-positive classical DM-associated RP-ILD and treated with intensive immunosuppressive therapy. However, the titer of anti-MDA5 antibody did not decrease satisfactorily, and plasma exchange was alternatively initiated. The titer decreased remarkably, and she obtained disease remission. Similarly, a 63-year-old woman presented with stiffness of the neck and hands, fever and cough. She was also diagnosed as anti-MDA5 antibody-positive classical DM-associated RP-ILD, because she had skin eruptions, slight muscle weakness, an elevation in anti-MDA5 antibody, and RP-ILD. She was unresponsive to intensive immunosuppressive therapy, but plasma exchange successfully improved the titer of anti-MDA5 antibody, the symptoms, and the findings of computed tomography. Conclusions: Although anti-MDA5 antibody-positive DM-associated RP-ILD has a high mortality rate, this report suggests the usefulness of plasma exchange to improve the prognosis.https://doi.org/10.1177/11795476211036322 |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Rina Takahashi Tadashi Yoshida Kohkichi Morimoto Yasushi Kondo Jun Kikuchi Shuntaro Saito Sho Ishigaki Yuko Kaneko Tsutomu Takeuchi Hiroshi Itoh Mototsugu Oya |
spellingShingle |
Rina Takahashi Tadashi Yoshida Kohkichi Morimoto Yasushi Kondo Jun Kikuchi Shuntaro Saito Sho Ishigaki Yuko Kaneko Tsutomu Takeuchi Hiroshi Itoh Mototsugu Oya Successful Treatment of Anti-MDA5 Antibody-Positive Dermatomyositis-Associated Rapidly Progressive-Interstitial Lung Disease by Plasma Exchange: Two Case Reports Clinical Medicine Insights: Case Reports |
author_facet |
Rina Takahashi Tadashi Yoshida Kohkichi Morimoto Yasushi Kondo Jun Kikuchi Shuntaro Saito Sho Ishigaki Yuko Kaneko Tsutomu Takeuchi Hiroshi Itoh Mototsugu Oya |
author_sort |
Rina Takahashi |
title |
Successful Treatment of Anti-MDA5 Antibody-Positive Dermatomyositis-Associated Rapidly Progressive-Interstitial Lung Disease by Plasma Exchange: Two Case Reports |
title_short |
Successful Treatment of Anti-MDA5 Antibody-Positive Dermatomyositis-Associated Rapidly Progressive-Interstitial Lung Disease by Plasma Exchange: Two Case Reports |
title_full |
Successful Treatment of Anti-MDA5 Antibody-Positive Dermatomyositis-Associated Rapidly Progressive-Interstitial Lung Disease by Plasma Exchange: Two Case Reports |
title_fullStr |
Successful Treatment of Anti-MDA5 Antibody-Positive Dermatomyositis-Associated Rapidly Progressive-Interstitial Lung Disease by Plasma Exchange: Two Case Reports |
title_full_unstemmed |
Successful Treatment of Anti-MDA5 Antibody-Positive Dermatomyositis-Associated Rapidly Progressive-Interstitial Lung Disease by Plasma Exchange: Two Case Reports |
title_sort |
successful treatment of anti-mda5 antibody-positive dermatomyositis-associated rapidly progressive-interstitial lung disease by plasma exchange: two case reports |
publisher |
SAGE Publishing |
series |
Clinical Medicine Insights: Case Reports |
issn |
1179-5476 |
publishDate |
2021-07-01 |
description |
Background: Patients with anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis (DM) are frequently accompanied by rapidly progressive-interstitial lung disease (RP-ILD). They are often refractory to intensive immunosuppressive therapy and have poor prognosis. Case presentation: A 73-year-old woman presented with fever, cold symptoms, and skin eruption for a month. She also exhibited muscle weakness on upper extremities slightly. The titer of anti-MDA5 antibody was extremely high, and computed tomography showed ground glass opacity and reticular shadows in the lungs. She was diagnosed as anti-MDA5 antibody-positive classical DM-associated RP-ILD and treated with intensive immunosuppressive therapy. However, the titer of anti-MDA5 antibody did not decrease satisfactorily, and plasma exchange was alternatively initiated. The titer decreased remarkably, and she obtained disease remission. Similarly, a 63-year-old woman presented with stiffness of the neck and hands, fever and cough. She was also diagnosed as anti-MDA5 antibody-positive classical DM-associated RP-ILD, because she had skin eruptions, slight muscle weakness, an elevation in anti-MDA5 antibody, and RP-ILD. She was unresponsive to intensive immunosuppressive therapy, but plasma exchange successfully improved the titer of anti-MDA5 antibody, the symptoms, and the findings of computed tomography. Conclusions: Although anti-MDA5 antibody-positive DM-associated RP-ILD has a high mortality rate, this report suggests the usefulness of plasma exchange to improve the prognosis. |
url |
https://doi.org/10.1177/11795476211036322 |
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