muramidase and Muscular-Diseases

A 65-year-old man was diagnosed with systemic sclerosis on the basis of skin thickening and positivity of anti-Scl-70 antibodies. Because myogenic enzymes, such as creatinine phosphokinase and aldorase, were also elevated, myopathy or myositis associated with systemic sclerosis was considered. Muscle magnetic resonance imaging and gallium scintigraphy did not show abnormalities. Findings of muscle biopsy demonstrated presence of noncaseating granulomas with multinucleated giant cells. In addition, serum angiotensin-converting enzyme and lysozyme were elevated, and therefore a diagnosis of sarcoid myopathy was made. Further, renal sarcoidosis was revealed with renal biopsy. Prednisolone (40 mg/day) improved both the myopathy and nephritis. Sarcoid myopathy is a rare condition, but it should be considered when myogenic enzymes are elevated in the patient with systemic sclerosis. Further, muscle biopsy may be essential to make an accurate diagnosis in such condition.

Topics: Aged; Biopsy; Giant Cells; Granuloma; Humans; Kidney Diseases; Male; Muramidase; Muscle, Skeletal; Muscular Diseases; Prednisolone; Renin; Sarcoidosis; Scleroderma, Systemic; Treatment Outcome

Topics: Adjuvants, Immunologic; Animals; Antibody Formation; Antigens; Carbon; Chickens; Corynebacterium; Glycopeptides; Granuloma; Hypersensitivity, Delayed; Immune Sera; Immunologic Memory; Injections, Intramuscular; Macrophages; Mononuclear Phagocyte System; Muramidase; Muscular Diseases; Mycobacterium; Mycobacterium tuberculosis; Serum Albumin; Stimulation, Chemical; Thymus Gland; Time Factors