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Successful treatment of antisynthetase syndrome presenting as rhabdomyolysis with rituximab

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Abstract

Rhabdomyolysis is a syndrome of muscle necrosis with subsequent release of intracellular content into the blood. There are various causes for rhabdomyolysis that include trauma, medications and rarely autoimmune conditions such as autoimmune myositis. Antisynthetase syndrome is an autoimmune condition characterized by positive antisynthetase antibody, myopathy, lung disease and arthritis. To our knowledge, rhabdomyolysis in antisynthetase syndrome has not been reported in the literature. In this report, we present a patient who presented with features of rhabdomyolysis and was diagnosed with antisynthetase syndrome. This patient was treated with systemic steroids with partial improvement, followed by rituximab, which led to significant improvement in his condition. In addition, we summarize all cases reported in the literature of inflammatory myopathy-associated rhabdomyolysis.

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References

  1. Zutt R, van der Kooi AJ, Linthorst GE, Wanders RJ, de Visser M (2014) Rhabdomyolysis: review of the literature. Neuromuscul Disord 24(8):651–659. https://doi.org/10.1016/j.nmd.2014.05.005

    Article  PubMed  CAS  Google Scholar 

  2. Bosch X, Poch E, Grau JM (2009) Rhabdomyolysis and acute kidney injury. N Engl J Med 361(1):62–72. https://doi.org/10.1056/NEJMra0801327

    Article  PubMed  CAS  Google Scholar 

  3. Mizoguchi F, Takada K, Ishikawa K, Mizusawa H, Kohsaka H, Miyasaka N (2015) A case of dermatomyositis with rhabdomyolysis, rescued by intravenous immunoglobulin. Mod Rheumatol 25(4):646–648. https://doi.org/10.3109/14397595.2013.843753

    Article  PubMed  Google Scholar 

  4. Joshi D, Kumar N, Rai A (2009) Dermatomyositis presenting with rhabdomyolysis and acute renal failure; an uncommon manifestation. Ann Indian Acad Neurol 12(1):45–47. https://doi.org/10.4103/0972-2327.48853

    Article  PubMed  PubMed Central  Google Scholar 

  5. Fukunaga E, Kunishige M, Mitsui T, Endo I, Oshima Y, Ohnishi Y, Kuroda Y, Hara S, Matsumoto T (2002) Severe dermatomyositis with rhabdomyolysis and paralytic ileus: a case successfully treated with plasmapheresis and intravenous immunoglobulin. Eur J Neurol 9(6):697–698

    Article  PubMed  CAS  Google Scholar 

  6. Caccamo DV, Keene CY, Durham J, Peven D (1993) Fulminant rhabdomyolysis in a patient with dermatomyositis. Neurology 43(4):844–845

    Article  PubMed  CAS  Google Scholar 

  7. Mahler M, Miller FW, Fritzler MJ (2014) Idiopathic inflammatory myopathies and the anti-synthetase syndrome: a comprehensive review. Autoimmun Rev 13(4–5):367–371. https://doi.org/10.1016/j.autrev.2014.01.022

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Knochel JP (1993) Mechanisms of rhabdomyolysis. Curr Opin Rheumatol 5(6):725–731

    Article  PubMed  CAS  Google Scholar 

  9. Brumback RA, Feeback DL, Leech RW (1992) Rhabdomyolysis in childhood. A primer on normal muscle function and selected metabolic myopathies characterized by disordered energy production. Pediatric clin N Am 39(4):821–858

    Article  CAS  Google Scholar 

  10. Yen TH, Lai PC, Chen CC, Hsueh S, Huang JY (2005) Renal involvement in patients with polymyositis and dermatomyositis. Int J Clin Pract 59(2):188–193. https://doi.org/10.1111/j.1742-1241.2004.00248.x

    Article  PubMed  Google Scholar 

  11. Tsai CN, Liu MF, Lin TS, Lin LH, Wang CR (2004) Rhabdomyolysis and acute renal failure in a polymyositis patient. Mod Rheumatol 14(5):422–423. https://doi.org/10.1007/s10165-004-0335-0

    Article  PubMed  Google Scholar 

  12. Rorive A, Fraipont V, Quatresooz P, Cataldo D, Dubois B, Fillet G (1999) [Clinical case of the month. A case of acute rhabdomyolysis]. Rev Med Liege 54(3):143–148

    PubMed  CAS  Google Scholar 

  13. Marks SH, McShane DJ, Mitchell DM (1976) Dermatomyositis following rhabdomyolysis. J Rheumatol 3(3):224–226

    PubMed  CAS  Google Scholar 

  14. Kofteridis DP, Malliotakis PI, Sotsiou F, Vardakis NK, Vamvakas LN, Emmanouel DS (1999) Acute onset of dermatomyositis presenting in pregnancy with rhabdomyolysis and fetal loss. Scand J Rheumatol 28(3):192–194

    Article  PubMed  CAS  Google Scholar 

  15. Kim HW, Choi JR, Jang SJ, Chang YS, Bang BK, Park CW (2005) Recurrent rhabdomyolysis and myoglobinuric acute renal failure in a patient with polymyositis. Nephrol Dial Transplant 20(10):2255–2258. https://doi.org/10.1093/ndt/gfh950

    Article  PubMed  Google Scholar 

  16. Farooq A, Choksi V, Chu A, Mankodi D, Shaharyar S, O’Brien K, Shankar U (2015) Severe rhabdomyolysis without systemic involvement: a rare case of idiopathic eosinophilic polymyositis. Case Rep Rheumatol 2015:908109. https://doi.org/10.1155/2015/908109

    Article  PubMed  PubMed Central  Google Scholar 

  17. Pinto-Lopes P, Carneiro-Leao L, Morais R, Pinheiro J, Vieira Lopes A, Bettencourt P (2017) Acute heart failure and rhabdomyolysis: a clue for the diagnosis of polymyositis with cardiac involvement. Reumatismo 69(2):78–83. https://doi.org/10.4081/reumatismo.2017.924

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

We would like to thank Dr. William Gunning for obtaining the electron microscopy images of the muscle biopsy.

Funding

No funding received for this research.

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Authors and Affiliations

Authors

Contributions

MS reviewed literature and contributed to writing, HS contributed to writing and reviewing; RS obtained pathologic specimen images and contributed to writing, NA supervised work and reviewed manuscript.

Corresponding author

Correspondence to Nezam Ibrahim Altorok.

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Authors declare that there is no conflict of interest.

Ethical approval

All procedures performed in this report were in accordance with the ethical standards of the University of Toledo institutional review board and the national research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

For publication of this case report, we obtained informed consent from the subject described in this report.

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Sabha, M.M., Simo, H.T., Shadid, R.M. et al. Successful treatment of antisynthetase syndrome presenting as rhabdomyolysis with rituximab. Rheumatol Int 38, 1125–1130 (2018). https://doi.org/10.1007/s00296-018-4025-1

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  • DOI: https://doi.org/10.1007/s00296-018-4025-1

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