Significant muscle hemorrhage associated with low molecular weight heparin in d ermatomyositi = Significant muscle hemorrhage associated with low molecular weight heparin in d ermatomyositi

다국어 초록 (Multilingual Abstract)

Dermatomyositis (DM) is an autoimmune idiopathic inflammatory myopathy with typical skin features, interstitial lung disease, myositis, mechanic’s hands. The patient is a 43-year-old Korean man. He visited local hospital and admitted. He developed right supraorbital edema and both leg cramping pain. Laboratory finding were D-dimer 395 ng/mL, AST 412 IU/L, ALT 217 IU/L, CPK 1,610 mg/dL and immunofluorescence for antinuclear antibodies, serum for anti-SM/RNP, anti-neutrophil cytoplasmic antibodies, anti-SSa,-SSb antibodies, anti-cardiolipin antibodies, anti ds DNA antibodies, anti-Jo-1 antibodies were all negative. Computed tomography showed that multifocal peribronchial consolidation and ground glass opacity in both lower lobe, especially in right subpleural area and effuision. A 1.5 cm-diameter filling defect in the distal right lower pulmonary vein. He refered to our hospital. He exhibitied DM-associated skin rashes; a heliotrope rash and edema on both eyelids, eruptions in both knuckles, prepatella, both shoulder and back. Neurologic examination showed no motor weakness. An electromyogram of muscles showed no definitive evidence of myopathy and polyneuropathy. Collectively, A diagnosis of amyopathic DM with suspected right pulmonary vein thromboembolism was made. Intravenous methylprednisolone (125 mg) and subcutaneous enoxaparin (5,000 IU) were given. Cutaneous symptoms and laboratory findings were improved gradually. After 10 days of treatment, the patient developed dyspnea, tachycardia, left thigh pain. His hemoglobin and blood pressure decreased 13.7 to 7.3 g/dL and 90/60 mmHg. Platelets, prothrombin time, activated partial prothromboplastin time, bleeding time were all normal. A CT scan showed hemorrhage of the left iliopsoas, iliacus and retroperitoneum. LMWH was stopped and 3 units of packed red cells were transfused. We applied a splint on his lower extremities with absolutely bed rest. Finally he recovered successfully and discharged.