Investigation and treatment course
Investigations during her first visit showed elevated
CK-total(2227IU/L), elevated anti-PM scl-75. High-resolution chest CT;
bilateral septal thickness, few honeycombing patterns (NSIP) with
bilateral pleural effusion, and Echocardiography showed borderline left
ventricular wall hypertrophy, and EKG was normal.
With the diagnosis of polymyositis, the patient was initially put on
1mg/kg of prednisolone, tapered over more than a month, and continued
with 10mg oral daily dose and azathioprine 100mg oral daily. The
symptoms have subsided over time.
Currently, she presents with a 2-month history of worsening joint pain.
2 weeks ago she had a decreased amount of urine and cola-colored change
of urine and bilateral flank pain. The current physical finding showed
elevated blood pressure i.e. 170/90mmhg, pale conjunctiva, and bilateral
costovertebral angle tenderness. Recent investigations have shown
moderate anemia hemoglobin of 9.2g/dl, positive ANA qualitative study,
total CK 2154IU/L(more than 15x elevated), decreased C3 level
(0.275g/dl ), normal c4 (0.275g/dl ), and elevated ant-dsDNA-IGG
(141.7 IU/L). The investigation summary is shown in Table 1 below
With the final diagnosis of Polymyositis-SLE overlap syndrome, she was
started on induction therapy with high dose methylprednisolone followed
by prednisolone and cyclophosphamide.