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Revista médica de Chile

versão impressa ISSN 0034-9887

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YANEZ V, Jorge; CISTERNAS M, Marcela; SALDIAS H, Velia  e  SALDIAS P, Fernando. Refractory dermatomyositis associated with chronic organizing pneumonia treated with rituximab: Report of one case. Rev. méd. Chile [online]. 2009, vol.137, n.1, pp.88-93. ISSN 0034-9887.  http://dx.doi.org/10.4067/S0034-98872009000100013.

Chronic organizing pneumonia (COP) has often been reported as a pulmonary manifestation of collagen vascular diseases, mainly rheumatoid arhritis, but the association of COP and dermatomyositis (DM) has rarely been documented. We report a 55 year-old woman with well-documented DM and a COP. She was refractory to steroids and two other immunosuppressive agents therapy (cyclophosphamide and azathioprine). Therefore, rituximab (2 x 1 g infusions) was used for treatment. During the following weeks her strength gradually increased while creatine kinase (CK), C reactive protein and erythrocyte sedimentation rate normalized. After 6 months, she had a relapse with increased muscle enzymes, fever and modérate muscle weakness. After a second course of rituximab (2 x 1 g infusions), the patient demonstrated a remarkable clinical response as indicated by an increase in muscle strength and moderate decline in creatine kinase levels. Lung abnormalities resolved significantly on high resolution chest CT sean. Thus, B-cell depletion therapy with rituximab used alone or in combination with other immunosuppressants may be a viable option in patients with polymyositis-dermatomyositis and pneumonia refractory to current therapies.

Palavras-chave : Dermatomyositis; Pneumonia; Rituximab.

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