Skip to main content

Advertisement

SpringerLink
Log in

Successful treatment with tacrolimus of progressive interstitial pneumonia associated with amyopathic dermatomyositis refractory to cyclosporine

  • Case Report
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

A 58-year-old male was admitted to our hospital because of periungual nailfold an erythema and erythematous rash on the dorsal joints of his hands and feet, but no muscle weakness. He was thus diagnosed to have amyopathic dermatomyositis. He had moderate hypoxemia and his chest computed tomography scans demonstrated bilateral ground-glass opacities, implicating complication with interstitial pneumonia. Therapy was initiated with pulsed methylprednisolone followed by high-dose corticosteroids, pulsed cyclophosphamide, and cyclosporine. The skin manifestations improved; however, the pulmonary infiltrates and hypoxemia deteriorated during the 2-month period of the treatment. The treatment was switched from cyclosporine to tacrolimus because of an inadequate clinical response to the therapy, and this resulted in the resolution of interstitial pneumonia. This case indicates that tacrolimus administration should be considered for patients with this life-threatening disorder when it is judged to be refractory to cyclosporine.

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

References

  1. Sontheimer RD (2009) Would a new name hasten the acceptance of amyopathic dermatomyositis (dermatomyositis sine myositis) as a distinctive subset within the idiopathic inflammatory dermatomyopathies spectrum of clinical illness? J Am Acad Dermatol 46:626–636

    Article  Google Scholar 

  2. Sontheimer RD, Miyagawa S (2003) Potentially fatal interstitial lung disease can occur in clinically amyopathic dermatomyositis. J Am Acad Dermatol 48:797–798

    Article  PubMed  Google Scholar 

  3. Miyazaki E, Ando M, Muramatsu T, Fukami T, Matsuno O, Nureki S, Ueno T, Tsuda T, Kumamoto T (2007) Early assessment of rapidly progressive interstitial pneumonia associated with amyopathic dermatomyositis. Clin Rheumatol 26:436–439

    Article  PubMed  Google Scholar 

  4. Shimojima Y, Ishii W, Kato T, Hoshi K, Matsuda M, Hashimoto T, Tanaka Y, Ikeda S (2003) Intractable skin necrosis and interstitial pneumonia in amyopathic dermatomyositis, successfully treated with cyclosporin A. Intern Med 42:1253–1258

    Article  PubMed  Google Scholar 

  5. Suda T, Fujisawa T, Enomoto N, Nakamura Y, Inui N, Naito T, Hashimoto D, Sato J, Toyoshima M, Hashizume H, Chida K (2006) Interstitial lung diseases associated with amyopathic dermatomyositis. Eur Respir J 28:1005–1012

    Article  CAS  PubMed  Google Scholar 

  6. Ideura G, Hanaoka M, Koizumi T, Fujimoto K, Shimojima Y, Ishii W, Matsuda M, Ikeda S (2007) Interstitial lung disease associated with amyopathic dermatomyositis: review of 18 cases. Respir Med 101:1406–1411

    Article  PubMed  Google Scholar 

  7. Siekierka JJ, Hung SH, Poe M, Lin CS, Sigal NH (1989) A cytosolic binding protein for the immunosuppressant FK506 has peptidyl-prolyl isomerase activity but is distinct from cyclophilin. Nature 341:755–757

    Article  CAS  PubMed  Google Scholar 

  8. Shihab FS, Andoh TF, Tanner AM, Noble NA, Border WA, Franceschini N, Bennett WM (1996) Role of transforming growth factor-beta 1 in experimental chronic cyclosporine nephropathy. Kidney Int 49:1141–1151

    Article  CAS  PubMed  Google Scholar 

  9. Baan CC, van Riemsdijk-van Overbeeke IC, Balk AH, Vantrimpont PM, Mol WM, Knoop CJ, Niesters HG, Maat LP, Weimar W (2001) Conversion from cyclosporin A to tacrolimus is safe and decreases blood pressure, cholesterol levels and TGF-beta 1 type I receptor expression. Clin Transplant 15:276–283

    Article  CAS  PubMed  Google Scholar 

  10. Meloni F, Cascina A, Paschetto E, Marone Bianco A, Morosini M, Pellegrini C, Fietta A, Vitulo P, Pozzi E, Vigano M (2003) Monocyte chemoattractant protein-1 levels in bronchoalveolar lavage fluid of lung-transplanted patients treated with tacrolimus as rescue treatment for refractory acute rejection. Transplant Proc 35:1523–1526

    Article  CAS  PubMed  Google Scholar 

  11. Wynn TA (2008) Cellular and molecular mechanisms of fibrosis. J Pathol 214:199–210

    Article  CAS  PubMed  Google Scholar 

  12. Oddis CV, Sciurba FC, Elmagd KA, Starzl TE (1999) Tacrolimus in refractory polymyositis with interstitial lung disease. Lancet 353:1762–1763

    Article  CAS  PubMed  Google Scholar 

  13. Fau Wilkes Mr, Sereika SM, Fau Sereika Sm, Fertig N, Fau FN, Lucas MR, Fau Lucas Mr, Oddis CV, Oddis CV (2005) Treatment of antisynthetase-associated interstitial lung disease with tacrolimus. Arthritis heum 52(8):2439–2446

    Article  Google Scholar 

Download references

Disclosures

None.

Author information

Authors and Affiliations

  1. Department of Internal Medicine 3, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama, Yufu, Oita, 879-5593, Japan

    Masaru Ando, Eishi Miyazaki, Mari Yamasue, Yukiko Sadamura, Toshihiro Ishii, Ryuichi Takenaka, Takeo Ito, Shin-ichi Nureki & Toshihide Kumamoto

Authors
  1. Masaru Ando
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eishi Miyazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mari Yamasue
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yukiko Sadamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Toshihiro Ishii
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ryuichi Takenaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takeo Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shin-ichi Nureki
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Toshihide Kumamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masaru Ando.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ando, M., Miyazaki, E., Yamasue, M. et al. Successful treatment with tacrolimus of progressive interstitial pneumonia associated with amyopathic dermatomyositis refractory to cyclosporine. Clin Rheumatol 29, 443–445 (2010). https://doi.org/10.1007/s10067-009-1358-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-009-1358-x

Keywords

Search

Navigation