epiglucan and Polymyositis

A 73-year-old woman with polymyositis, who had received corticosteroids and immune-suppressive agents, was admitted to our hospital because of general fatigue and severe cough. Chest X-ray film and CT scan showed a large tumor shadow in the left upper lobe and several ground-glass opacities (GGOs) scattered in both lungs. As the white blood cell and C-reactive protein levels were elevated, pnueumonia was suspected and antibiotics were administered. Subsequently, Nocardia spp. was cultured from the sputum and pulmonary nocardiosis was established. She gradually recovered after sulfamethoxazole-trimethoprim (ST) administration. The pretreatment serum beta-D-glucan level was highly elevated and decreased in parallel with clinical feature. In general, ST should be administered for 6 months to treat pulmonary nocardiosis in a compromised host. It is possible that P3-D-glucan may be a useful marker to treat pulmonary nocardiosis in patients with polymyositis.

Topics: Aged; beta-Glucans; Female; Humans; Immunocompromised Host; Nocardia Infections; Polymyositis

Pulmonary diseases are important cause of morbidity and mortality in patients with PM/DM. Thirteen (27%) out of 49 PM/DM patients in the study had developed respiratory failure. Respiratory failure resulted form interstitial pneumonitis (i.p.) in 6, pulmonary infection in 2 and both in 5 patients with PM/DM. Respiratory failure was fatal in PM/DM patients with pulmonary diseases and eleven of the 13 patients expired. More importantly, 2 PM/DM patients with respiratory failure had responded to chemotherapy, if it was due to pulmonary infection. Accordingly, it is almost important to distinguish i.p. and infection for the cause of respiratory failure. However, plain chest X-ray as well as standard laboratory tests failed to differentiate i.p. and pulmonary infection. On the other hand, high resolution CT of the lungs, serum endotoxin and serum beta-D-glucan were found to be useful for the differentiation of these conditions associated with respiratory failure in PM/DM patients. And additionally low serum level of IgG and lymphopenia at the onset of respiratory failure may suggest that the patients may have pulmonary infection rather than i.p.

Topics: Adult; beta-Glucans; Biomarkers; Dermatomyositis; Diagnosis, Differential; Endotoxins; Female; Glucans; Humans; Immunoglobulin G; Lung Diseases, Interstitial; Lymphocyte Count; Male; Middle Aged; Pneumonia; Polymyositis; Prognosis; Respiratory Insufficiency; Tomography, X-Ray Computed