J Korean Rheum Assoc.  2007 Jun;14(2):166-170. 10.4078/jkra.2007.14.2.166.

A Case of Hypercapnic Respiratory Failurein a Patient with Eosinophilic Polymyositis

• Shin JA
• Park KM
• Park YJ
• Kim YH
• Kwon SS
• Sung MS
• Min JK

• KMID: 1526435
• DOI: http://doi.org/10.4078/jkra.2007.14.2.166

Abstract

Eosinophilic infiltration into skeletal muscles has been rarely reported in a variety of conditions such as parasite infection, sarcoidosis, rheumatoid arthritis, eosinophilia-myalgia syndrome, and idiopathic hypereosinophilic syndrome. Eosinophilic myositis (EM) is one of idiopathic inflammatory muscle diseases associated with muscle and/or blood eosiophilia. The case of EM complicated with hypercapnic respiratory failure has been extremely rarely reported. A 61-year-old woman was admitted with sudden-onset pain in both calves. She had elevated serum muscle enzymes and peripheral eosinophil count. Findings of electromyography were consistent with inflammatory myopathy. MRI showed diffuse hyperintensity of calf muscles on T2-weighted and enhanced T1 images. Muscle biopsy showed eosinophils' infiltration in the endomysium and perivascular area. During the diagnostic work-up, she presented with hypercapnic respiratory failure. She was successfully treated with mechanical ventilation and high doses of prednisolone. This case suggests EM can cause respiratory failure secondary to respiratory muscle involvement.

Keyword

Eosinophilic polymyositis (EM); Hypercapnic respiratory failure

MeSH Terms

Arthritis, Rheumatoid
Biopsy
Electromyography
Eosinophilia-Myalgia Syndrome
Eosinophils*
Female
Humans
Hypereosinophilic Syndrome
Magnetic Resonance Imaging
Middle Aged
Muscle, Skeletal
Muscles
Myositis
Parasites
Polymyositis*
Prednisolone
Respiration, Artificial
Respiratory Insufficiency
Respiratory Muscles
Sarcoidosis
Prednisolone

Figure

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  Fig. 1. Magnetic resonance imaging through both legs of patient demonstrating increased T2 and enhanced T1 signal involving the anterior and posterior compartment (A, enhanced T1 weighted image, coronal view B, enhanced T1 weighted image, transverse view, C, T2 weighted image, transverse view).

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  Fig. 2. Clinical course of the patient.

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  Fig. 3. The infiltration of eosinophils and lymphocytes are seen in the endomysium that spares perimysium and epimysium. A perivascular eosinophilic infiltration are also seen. Sections stained with hematoxylin and eosin (H&E) (Original magnification 40 in A, 100 in B).

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