Letters to the EditorSymptomatic myopathy in hepatitis C infection without interferon therapy
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Infectious Complications in Polymyositis and Dermatomyositis: A Series of 279 Patients
2011, Seminars in Arthritis and RheumatismCitation Excerpt :We found 10 cases of PM/DM patients exhibiting hepatitis C virus infection (77-86, present series). In the majority of patients, hepatitis C virus infection preceded the onset of PM/DM (77-86, present series). Reactivation of chronic hepatitis B has been described in 2 DM patients; hepatitis B reactivation occurred 2 and 4 months after administration of steroid therapy, respectively (86, present series).
To assess the prevalence and characteristics of severe pyogenic, nonpyogenic, and opportunistic infections in polymyositis and dermatomyositis (PM/DM) patients and to evaluate the predictive values for infections on clinical presentation and biochemical findings of PM/DM to detect patients at risk for such infections.
The medical records of 279 consecutive PM/DM patients in 3 medical centers were reviewed.
One hundred four severe infections occurred in our patients (37.3%), ie, pyogenic (n = 71) and nonpyogenic/opportunistic infections (n = 33). Pyogenic infections were mainly due to aspiration pneumonia (n = 46) and calcinosis cutis infection. Thirty-three PM/DM patients developed nonpyogenic/opportunistic infections that were due to the following: Candida albicans, Pneumocystis jiroveci, Aspergillus fumigatus, Geotrichum capitatum, Mycobacterium (avium-intracellulare complex, xenopi, marinum, peregrinum, tuberculosis), Helicobacter heilmanii, cytomegalovirus, herpes simplex and zoster virus, hepatitis B and C, JC virus, Leishmania major, Strongyloides stercoralis. Esophageal dysfunction, ventilatory insufficiency, malignancy, and lymphopenia were significantly more frequent in the group of PM/DM patients with infections.
Our study underscores the high frequency of infections in PM/DM, resulting in an increased mortality rate. Our results suggest that prophylaxis against pyogenic infections should be routinely recommended for patients with PM/DM, including regular physical examination of lungs to depict aspiration pneumonia as well as risk factors of aspiration pneumonia. Finally, because a great variety of micro-organisms may be responsible for opportunistic infections, it seems difficult to initiate primary prophylaxis in PM/DM patients exhibiting risk factors for opportunistic infections.
Infections in polymyositis and in dermatomyositis
2009, Presse MedicaleLes infections constituent une complication grave des polymyosites/dermatomyosites, dont elles représentent l’une des premières causes de mortalité, aboutissant au décès des patients dans 9 à 30 % des cas.
Elles sont favorisées par les caractéristiques propres des polymyosites/dermatomyosites : âge, lymphopénie, troubles pharyngo-œsophagiens, hypoventilation alvéolaire par atteinte des muscles striés respiratoires, pneumopathie infiltrante diffuse.
La corticothérapie et le traitement immunosuppresseur constituent aussi des facteurs de risque d’infections au cours des polymyosites/dermatomyosites.
Les infections peuvent être pyogènes ou opportunistes. Les mycobactéries, Pneumocystis jiroveci et Candida sp. sont les microorganismes pathogènes les plus fréquemment responsables d’infections opportunistes.
La prophylaxie primaire de la pneumocystose devrait être instituée chez les patients ayant des taux de lymphocytes CD4 inférieurs à 250/mm3.
La vaccination (antipneumococcique, antigrippale) devrait être proposée aux patients traités de manière prolongée par agents immunosuppresseurs.
Infections result in increased mortality rates in patients with polymyositis/dermatomyositis, leading to death in 9 to 30% of cases.
The following parameters can be considered of predictive value for infection onset in polymyositis/dermatomyositis: age, lymphopenia, esophageal dysfunction, ventilatory insufficiency, interstitial lung disease, calcinosis cutis, as well as higher mean daily doses of steroids.
A great variety of microorganisms may be responsible for pyogenic and opportunistic infections in polymyositis/dermatomyositis. Opportunistic infections are more often due to mycobacteria and fungi (Pneumocystis jiroveci, Candida sp.).
Because a great variety of microorganisms may be responsible for opportunistic infections, it seems difficult to initiate primary prophylaxis in patients with polymyositis/dermatomyositis who exhibit risk factors for opportunistic infections. Primary prophylaxis of Pneumocystis jiroveci pneumonia should be given in the group of patients exhibiting CD4-cell count lower than 250/mm3.
Vaccination should be performed in patients with polymyositis/dermatomyositis, prior to immunosuppressive therapy institution.
Acute polymyositis during treatment of acute hepatitis C with pegylated interferon alpha-2b
2005, Digestive and Liver DiseaseHepatitis C virus is not cleared after primary infection in 50–85% of subjects exposed to hepatitis C virus. Anti-viral treatment during the early phase of infection significantly enhances the likelihood of a sustained clearance of hepatitis C virus. Although, a variety of autoimmune-related side effects have been observed during interferon therapy for chronic hepatitis, immuno-mediated adverse reactions have not been reported during treatment of acute hepatitis C.
We describe the case of a patient who developed acute hepatitis C virus infection and, while receiving pegylated interferon alpha-2b monotherapy, developed a severe polymyositis. This case illustrates the potential risk of autoimmunity by interferon, also for acute hepatitis, and underlines the importance of a prompt diagnosis and a rapid discontinuation of interferon treatment for an improvement of clinical outcomes.
Association between polymyositis and hepatitis C virus infection: Treatment-related difficulties
2000, Revue de Medecine InterneDe nombreuses manifestations auto-immunes ont été décrites au cours de l'infection par le virus de l'hépatite C. Nous décrivons quatre cas d'une association entre polymyosite et infection par le virus de l'hépatite C. L'évolution et les difficultés du traitement sont discutées.
Dans une série de 510 patients inclus de façon consécutive dans l'étude, souffrant d'une infection par le virus de l'hépatite C, nous avons recensé quatre cas de polymyosite. Le traitement de la polymyosite par corticoïdes a aggravé la cytolyse hépatique dans deux cas et entraîné une réactivation sévère de l'hépatite chez un patient. La polymyosite s'est aggravée sous interféron-; dans un dans un cas. Une stabilité clinico-biologique de l'atteinte musculaire a été observée chez un autre patient. Une aggravation nette de la polymyosite à l'arrêt du traitement par interféron s'est produite chez deux patients, avec apparition d'une dyspnée. Dans ces deux derniers cas, une amélioration de la polymyosite sans aggravation biologique de l'hépatite virale C a été obtenue par un traitement par veinoglobulines.
Ces observations suggèrent une association entre la polymyosite et l'infection par le virus de l'hépatite C. Compte tenu du risque d'aggravation de l'hépatite virale par le traitement par corticoïdes, des perfusions de veinoglobulines pourraient être proposées dans cette forme particulière de polymyosite.
Chronic hepatitis C virus infection is often associated with various auto-immune disorders. We report four cases of an association between polymyositis and hepatitis C virus infection. The course and the difficulties of therapy are discussed.
Among 510 consecutive patients infected by viral hepatitis C, we report four cases of polymyositis. Corticosteroids increased serum alanine aminotransferase levels in two cases, leading to severe liver injury in one patient. Worsening of polymyositis under interferon-α therapy was observed in one case. Clinical and biological stability were reported in another case. Aggravation of polymyositis with severe muscle weakness and dyspnea occurred in two patients after disruption of interferon-α treatment. Intravenous gamma globulins subsequently improved their condition, without biological worsening of viral hepatitis.
These observations suggest an association between hepatitis C virus infection and polymyositis. Because corticosteroids can induce adverse effects in the liver, intravenous gamma globulins could be used for the treatment of this particular form of polymyositis.
Hepatitis C-associated autoimmune disorders
1998, Rheumatic Disease Clinics of North AmericaHepatitis C virus (HCV) has a prevalence of 1% to 2% in the general population and is a common cause of liver disease. Those at greatest risk for HCV infection are patients with a history of blood transfusion, intravenous drug use, sexual promiscuity, sexually transmitted disease, sexual and household contacts of HCV–infected patients, or low socioeconomic status. Persistent infection occurs in 50% to 80% of those infected and may lead to the development of chronic liver disease, cirrhosis, or hepatocellular carcinoma.4, 5, 6, 138, 147 Within the past several years, a broad clinical spectrum of immune and autoimmune perturbations have been associated with HCV infection (Table 1). Although cause and effect remain to be established, this overview presents basic information regarding HCV infection, HCV–associated immune and autoimmune abnormalities, and therapeutic strategies and toxicities documented in patients with HCV–associated disorders.
Neurological complications of hepatitis C infections
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