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Abstract: The patient, a female, was 89 years old. She came to our hospital several times with erythema, itching of the skin, swelling of both eyelids as well as the face, and also with muscle weakness of both lower limbs, and was considered to have a high possibility of dermatomyositis. However, the symptoms were not relieved by the use of methylprednisolone tablets. For further treatment, the patient came to the hospital and was given medication, and her symptoms were basically controlled.
Basic information】Female, 89 years old
Disease Type】Dermatomyositis
Hospital】Xiangya Second Hospital of Central South University
Date of consultation】April 2022
Treatment plan】Medication (methotrexate tablets)
[Treatment Period] 1 day of outpatient visit, given medication to take at home, 3 months of outpatient follow-up
Effectiveness of treatment】Erythema and pruritus disappeared
I. Initial consultation
When we first saw the patient, the patient needed to be supported by family members to walk. We could see erythema on the patient’s face and arms, and swelling of the eyelids and face. The patient reported weakness of the lower extremities and itching all over the body, and had previously taken oral methylprednisolone tablets, but the symptoms did not resolve. The patient also had a history of hypertension, hyperlipidemia, and epilepsy, but was on long-term medication and was well controlled. After that, I examined the patient. The patient’s temperature was 37.1℃, pulse rate was 93 beats/min, blood pressure was 115/59mmHg, anti-SSA/Ro antibody was positive, and blood sedimentation was 21mm/h. The diagnosis was dermatomyositis.
II. Treatment history
Considering the patient’s previous treatment with glucocorticoid, methotrexate tablets, which was not effective, the patient was switched to immunosuppressant, methotrexate tablets. The patient experienced mild nausea, vomiting and other gastrointestinal reactions during the administration of the drug. The patient was informed that this was an adverse reaction to the drug, and in view of the mild adverse reaction, the patient was not treated, and the patient’s adverse reaction subsided after two days and the drug was not changed. In addition, for the patient’s hypertension, hyperlipidemia and epilepsy, I instructed the patient to continue to take the previous medication for control. In addition, the patient should perform moderate exercise in general to avoid muscle atrophy.
III. Treatment effect
After the patient took methotrexate tablets, the erythema all over the body became lighter, the itching symptoms were relieved, the muscle weakness of the lower limbs was improved, the swelling of both eyelids and face was reduced, and each review was better than the previous one. The patient’s blood pressure, blood lipids and epilepsy were well controlled, and the blood sedimentation and other indicators gradually decreased. The results of physical examination were normal, and the patient complained of no other physical discomfort, fair diet and mental health, and clear consciousness.
IV. Precautions
Dermatomyositis is a chronic disease with a long recovery time. I instructed the patient to take medication on time and not to give up taking medication because of the long treatment period, otherwise he may not get good medication effect, and it may lead to recurrence of erythema and itching. When you go out, you should remember to wear an umbrella or apply sunscreen to avoid the sunlight aggravating the local pigmentation. In terms of diet, you should not eat spicy and stimulating food, and you should also exercise properly in order to strengthen your body and avoid muscle atrophy. In addition, family members should give support to the patient, pay more attention to and comfort the patient.
V. Personal insight
Dermatomyositis has a long course and patients are prone to recurrent erythema and pruritus, and the disease is also easily confused with eczema and urticaria, therefore, they should seek medical advice promptly and should not use medication blindly. In addition, some patients with dermatomyositis may not be effective with glucocorticoid therapy, just like the patient in this case, after taking mepronil tablets, the symptoms are not relieved well, at this time, you should also go to the hospital in time to adjust the treatment plan under the guidance of the doctor and change the oral medication to methotrexate tablets, and because of the long duration of the disease, it is easy to confuse with other diseases, so you must adhere to the medication after a clear diagnosis.