Skip to main content

Advertisement

SpringerLink
Log in

Dilemma in management of hemorrhagic myositis in dermatomyositis

  • Case Based Review
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

Dermatomyositis (DM) is a rare inflammatory disorder affecting the muscle and skin. DM patients can present with spontaneous muscle hemorrhage, a potentially fatal complication. The best practice for management of hemorrhagic myositis in these patients remains unclear. Here we discuss the case of a patient who presented with progressive muscle weakness and intermittent rash that was diagnosed with dermatomyositis. During admission, she developed spontaneous hemorrhagic myositis of the right pectoralis major treated with surgical evacuation. She also developed a spontaneous left anterior thigh hematoma which was treated conservatively. She recovered and showed no evidence of recurrent bleeding at either location. We performed a literature review and identified ten cases of spontaneous hemorrhage in DM patients, with a 60% mortality rate among reported cases. Given the high mortality rate associated with spontaneous hemorrhage in DM patients, it is important for physicians to be aware of the diagnosis, workup, and management strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bernatsky S, Joseph L, Pineau CA, Belisle P, Boivin JF, Banerjee D, Clarke AE (2009) Estimating the prevalence of polymyositis and dermatomyositis from administrative data: age, sex and regional differences. Ann Rheum Dis 68(7):1192–1196. https://doi.org/10.1136/ard.2008.093161

    Article  CAS  PubMed  Google Scholar 

  2. Bendewald MJ, Wetter DA, Li X, Davis MD (2010) Incidence of dermatomyositis and clinically amyopathic dermatomyositis: a population-based study in Olmsted County Minnesota. Arch Dermatol 146(1):26–30. https://doi.org/10.1001/archdermatol.2009.328

    Article  PubMed  Google Scholar 

  3. Krathen MS, Fiorentino D, Werth VP (2008) Dermatomyositis. Curr Dir Autoimmun 10:313–332. https://doi.org/10.1159/000131751

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Yamagishi M, Tajima S, Suetake A, Kawakami H, Watanabe T, Kuriyama H, Takada T, Suzuki E, Gejyo F (2009) Dermatomyositis with hemorrhagic myositis. Rheumatol Int 29(11):1363–1366. https://doi.org/10.1007/s00296-008-0821-3

    Article  PubMed  Google Scholar 

  5. Higashi Y, Mera K, Kanzaki T, Kanekura T (2009) Fatal muscle haemorrhage attributable to heparin administration in a patient with dermatomyositis. Clin Exp Dermatol 34(3):448–449. https://doi.org/10.1111/j.1365-2230.2008.02952.x

    Article  CAS  PubMed  Google Scholar 

  6. Hanawa F, Inozume T, Harada K, Andou N, Kawamura T, Shibagaki N, Shimada S (2013) A case of dermatomyositis accompanied by spontaneous intramuscular hemorrhage despite normal coagulability. Rheumatol Int 33(11):2949–2950. https://doi.org/10.1007/s00296-012-2492-3

    Article  PubMed  Google Scholar 

  7. Van Gelder H, Wu KM, Gharibian N, Patel DB, Clements PJ, Heinze ER, Morris RI, Wong AL (2014) Acute hemorrhagic myositis in inflammatory myopathy and review of the literature. Case Rep Rheumatol 2014:639756. https://doi.org/10.1155/2014/639756

    Article  PubMed  PubMed Central  Google Scholar 

  8. Chen YH, Wu PC, Ko PY, Lin YN (2015) Retroperitoneal hematoma mimicking exacerbation of dermatomyositis. Intern Med 54(8):995–996. https://doi.org/10.2169/internalmedicine.54.3195

    Article  PubMed  Google Scholar 

  9. Langguth DM, Wong RC, Archibald C, Hogan PG (2004) Haemorrhagic myositis associated with prophylactic heparin use in dermatomyositis. Ann Rheum Dis 63(4):464–465. https://doi.org/10.1136/ard.2003.010272

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Orrell RW, Johnston HM, Gibson C, Cass RM, Griggs RC (1998) Spontaneous abdominal hematoma in dermatomyositis. Muscle Nerve 21(12):1800–1803. https://doi.org/10.1002/(sici)1097-4598(199812)21:12%3c1800:aid-mus29%3e3.0.co;2-z

    Article  CAS  PubMed  Google Scholar 

  11. Miwa Y, Muramatsu M, Takahashi R, Wakabayashi K, Odai T, Isozaki T, Yajima N, Kasama T (2010) Dermatomyositis complicated with hemorrhagic shock of the iliopsoas muscle on both sides and the thigh muscle. Mod Rheumatol 20(4):420–422. https://doi.org/10.1007/s10165-010-0296-4

    Article  PubMed  Google Scholar 

  12. Touma L, Cohen S, Cassinotto C, Reinhold C, Barkun A, Tran VT, Banon O, Valenti D, Gallix B, Dohan A (2019) Transcatheter arterial embolization of spontaneous soft tissue hematomas: a systematic review. Cardiovasc Interv Radiol 42(3):335–343. https://doi.org/10.1007/s00270-018-2086-x

    Article  Google Scholar 

  13. Karapolat B, Tasdelen HA, Korkmaz HAA (2019) Conservative treatment of spontaneous rectus sheath hematomas: single center experience and literature review. Emerg Med Int 2019:2406873. https://doi.org/10.1155/2019/2406873

    Article  PubMed  PubMed Central  Google Scholar 

  14. Dohan A, Darnige L, Sapoval M, Pellerin O (2015) Spontaneous soft tissue hematomas. Diagn Interv Imaging 96(7–8):789–796. https://doi.org/10.1016/j.diii.2015.03.014

    Article  CAS  PubMed  Google Scholar 

  15. Li Y, Wang P, Li L, Wang F, Liu Y (2018) Increased risk of venous thromboembolism associated with polymyositis and dermatomyositis: a meta-analysis. Ther Clin Risk Manag 14:157–165. https://doi.org/10.2147/TCRM.S157085

    Article  PubMed  PubMed Central  Google Scholar 

  16. Wagner DD, Burger PC (2003) Platelets in inflammation and thrombosis. Arterioscler Thromb Vasc Biol 23(12):2131–2137. https://doi.org/10.1161/01.ATV.0000095974.95122.EC

    Article  CAS  PubMed  Google Scholar 

  17. Kohsaka H, Mimori T, Kanda T, Shimizu J, Sunada Y, Fujimoto M, Kawaguchi Y, Jinnin M, Muro Y, Ishihara S, Tomimitsu H, Ohta A, Sumida T (2019) Treatment consensus for management of polymyositis and dermatomyositis among rheumatologists, neurologists and dermatologists. Mod Rheumatol 29(1):1–19. https://doi.org/10.1080/14397595.2018.1521185

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Dr. Matthew Lewis for his review of the manuscript.

Funding

There was no funding provided for this report.

Author information

Authors and Affiliations

  1. Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Rm H3591, Stanford, CA, 94305, USA

    Julia M. Chandler & Irene L. Wapnir

  2. Stanford University School of Medicine, Stanford, CA, 94305, USA

    Yoo Jung Kim

  3. Department of Radiology, Stanford University School of Medicine, Stanford, CA, 94305, USA

    Justin L. Bauer

Authors
  1. Julia M. Chandler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoo Jung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Justin L. Bauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Irene L. Wapnir
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JC conceived the study and drafted and critically revised the manuscript. YK performed the literature search and drafted and critically revised the manuscript. JB critically revised the manuscript and provided guidance on radiologic findings. IW critically revised the manuscript and provided overall guidance for the project. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Julia M. Chandler.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest.

Informed consent

Informed consent was obtained from the patient described in the study, including permission for release of photographs.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chandler, J.M., Kim, Y.J., Bauer, J.L. et al. Dilemma in management of hemorrhagic myositis in dermatomyositis. Rheumatol Int 40, 331–336 (2020). https://doi.org/10.1007/s00296-019-04501-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-019-04501-7

Keywords

Search

Navigation