Chest
Volume 65, Issue 4, April 1974, Pages 403-407
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Clinical Investigations
Interstitial Pneumonitis in Association with Polymyositis and Dermatomyositis

https://doi.org/10.1378/chest.65.4.403Get rights and content

The clinical, roentgenologic, physiologic, and pathologic features of interstitial pulmonary fibrosis in association with polymyositis and dermatomyositis have been described from a retrospective analysis. Presenting complaints ranged from acute febrile pneumonitis without specific muscular symptoms to muscular symptoms with no clinical respiratory symptoms. All patients had diffuse abnormalities on thoracic roentgenograms. High-dosage corticosteroid therapy in those patients with acute febrile pneumonitis resulted in clinical, roentgenographic, and some physiologic improvement. Pulmonary involvement did not appear to progress in most patients with chronic disease who were receiving longterm corticosteroid therapy.

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MATERIALS AND METHODS

The records of all patients with a diagnosis of polymyositis or dermatomyositis seen at the Mayo Clinic during the interval 1965 through 1971 were searched (because of the wide overlap between polymyositis and dermatomyositis clinically, we have chosen to consider them as one group, PM-DM). Patients with clinical or laboratory evidence suggesting other associated collagen or vascular diseases were excluded. Diagnoses were confirmed by increased! values for serum glutamic-oxalacetic transaminase

RESULTS

Two hundred thirteen cases (139 in women and 74 in men) fulfilled the above criteria for a diagnosis of PM-DM. Of these, in ten (5 percent) there was prominent roentgenographic evidence of parenchymal pulmonary disease.

The ten patients were equally divided as to sex (Table 1). The mean age at onset of PM-DM or related pulmonary disease was 55 years (range, 31 to 76 years). Malignant neoplastic disease was not found in any case prior to the onset of the illness or on subsequent follow-up. The

DISCUSSION

Hepper et al2 noted three mechanisms for pulmonary complications in PM-DM: (1) aspiration of esophageal contents secondary to esophageal motility disorders; (2) hypoventilation and retention of secretions secondary to respiratory muscle weakness; and (3) parenchymal pulmonary disease in the form of IPF. In addition, with the increasing use of corticosteroids and certain other immunosuppressive agents, there are two possible iatrogenic mechanisms for pulmonary complications: (1) opportunistic

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There are more references available in the full text version of this article.

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Manuscript received September 4; accepted October 17.

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