Use of intravenous immunoglobulin in treatment for refractory dermatomyositis: a case report
- Authors: Uryas’yev O.M.1, Lazareva O.Y.1, Shakhanov A.V.1, Berstneva S.V.1, Lunyakov V.A.1, Alekseyenkova K.A.1, Dolzhenkova E.A.2, Ogorel’tseva E.V2
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Affiliations:
- Ryazan State Medical University
- Ryazan Regional Clinical Hospital
- Issue: Vol 33, No 1 (2025)
- Pages: 105-115
- Section: Clinical reports
- URL: https://bakhtiniada.ru/pavlovj/article/view/291052
- DOI: https://doi.org/10.17816/PAVLOVJ456412
- ID: 291052
Cite item
Abstract
INTRODUCTION: Dermatomyositis is a rare autoimmune disease. Its development is often associated with malignant solid tumors. Due to the polymorphism of clinical manifestations and low awareness of the primary care physicians of this disease, dermatomyositis remains undiagnosed for a long time, which leads to a late start of treatment. Untimely start of treatment is associated with a poor prognosis for this group of patients. Factors of poor prognosis include the development and progression of dysphagia and also refractoriness to the standard therapy with systemic glucocorticoids (sGC) and immunosuppressants, when it becomes necessary to use alternative methods of treatment, including intravenous immunoglobulin (IVIG).
AIM: Demonstration of a clinical case of dermatomyositis resistant to high-dose sGC and methotrexate therapy, that required high-dose IVIG therapy.
A clinical case of dermatomyositis in a female patient S., 56 years old, with cutaneous syndrome and muscle weakness, dysphagia and dysphonia is presented. On treatment with prednisolone 1 mg/kg a day orally, methotrexate 15 mg a week subcutaneously, clinical and laboratory dynamics was insignificant, poor tolerance to methotrexate did not permit to increase the dose. Taking into account progressing dysphagia, the medical commission took a decision about high-dose IVIG treatment at a dose 1g/kg once. After four weeks of therapy, clear positive clinical and laboratory dynamics was noted.
CONCLUSION: The described clinical case demonstrated the effectiveness and safety of IVIG for treatment of refractory dermatomyositis with insufficient effectiveness of the previous standard therapy with sGC and immune depressants.
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##article.viewOnOriginalSite##About the authors
Oleg M. Uryas’yev
Ryazan State Medical University
Email: uryasev08@yandex.ru
ORCID iD: 0000-0001-8693-4696
SPIN-code: 7903-4609
MD, Dr. Sci. (Med.), Professor
Russian Federation, RyazanOksana Yu. Lazareva
Ryazan State Medical University
Email: Lazareva-oksana@list.ru
ORCID iD: 0000-0001-9997-972X
SPIN-code: 5049-7048
MD, Cand. Sci. (Med.), Associate Professor
Russian Federation, RyazanAnton V. Shakhanov
Ryazan State Medical University
Email: shakhanovav@gmail.com
ORCID iD: 0000-0002-5706-9418
SPIN-code: 6378-4031
MD, Cand. Sci. (Med.), Associate Professor
Russian Federation, RyazanSvetlana V. Berstneva
Ryazan State Medical University
Email: berst.ru@mail.ru
ORCID iD: 0000-0002-3141-4199
SPIN-code: 6722-3203
MD, Dr. Sci. (Med.), Associate Professor
Russian Federation, RyazanVadim A. Lunyakov
Ryazan State Medical University
Email: lunyakov62@mail.ru
ORCID iD: 0000-0002-3370-7593
SPIN-code: 9628-5750
Russian Federation, Ryazan
Kseniya A. Alekseyenkova
Ryazan State Medical University
Email: xenia.alekseenkova@yandex.ru
ORCID iD: 0009-0008-5515-7319
Russian Federation, Ryazan
Elena A. Dolzhenkova
Ryazan Regional Clinical Hospital
Email: 79109012823@yandex.ru
ORCID iD: 0000-0002-4992-7953
SPIN-code: 7199-9177
MD.
Russian Federation, RyazanEkaterina V Ogorel’tseva
Ryazan Regional Clinical Hospital
Author for correspondence.
Email: ogorelceva@gmail.com
ORCID iD: 0009-0004-7447-3502
SPIN-code: 3863-3182
MD.
Russian Federation, RyazanReferences
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