Myositis
Infectious Complications in Polymyositis and Dermatomyositis: A Series of 279 Patients

https://doi.org/10.1016/j.semarthrit.2010.08.003Get rights and content

Objectives

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.

Methods

The medical records of 279 consecutive PM/DM patients in 3 medical centers were reviewed.

Results

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.

Conclusion

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.

Section snippets

Patient Population

From 1996 to 2009, 279 consecutive patients with a diagnosis of PM (n = 148) and DM (n = 131) were included in the study. No patient had other connective tissue disorders. The criteria for diagnosis of PM/DM were based on the following from Bohan and Peter (12, 13): (1) symmetric muscle weakness; (2) increased serum muscle enzymes; (3) myopathic changes on electromyography; (4) typical histologic findings on muscle biopsy; and (5) characteristic dermatologic manifestations.

First, the medical

Results

The 279 PM/DM patients consisted of 110 men and 169 women with a median age of 52 years at diagnosis. The median duration of follow-up in our patients was 36 months [range: 1 to 264 months].

Discussion

Infections have been increasingly described in patients with connective-tissue diseases; Falagas and coworkers (14) have, in fact, reported the incidence of infections to be 8 to 77.5%, 4.5 to 55%, and 26 to 46%, respectively, in patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and Wegener's granulomatosis. Few authors have found the frequency of infections to be 25 to 33% in small series of PM/DM patients (1, 5, 8, 9, 10, 11). Our study is, to our knowledge, the

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