Anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis with possible complication of thrombotic microangiopathy

J Dermatol. 2024 Mar;51(3):448-452. doi: 10.1111/1346-8138.17004. Epub 2023 Oct 13.

Abstract

This case study illustrates a 63-year-old Japanese woman who presented with anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis. She was administered a therapeutic regimen consisting of corticosteroids, tacrolimus, and cyclophosphamide. However, after a month of treatment, symptoms of confusion and depressive tendencies emerged, followed by the manifestation of hematuria, thrombocytopenia, and fragmented erythrocytes. A disintegrin-like and metalloprotease with thrombospondin type 1 motifs 13 activity was 45%. Thrombotic microangiopathy was contemplated, yet a definitive diagnosis remained elusive. She died 2 months after admission. Although the occurrence of thrombotic microangiopathy in patients with dermatomyositis is rare, the prognosis is poor, emphasizing the importance of prompt diagnosis and treatment.

Keywords: a disintegrin-like and metalloprotease with thrombospondin type 1 motifs 13; hematuria; immunosuppressive therapy; psychiatric symptom; thrombocytopenia.

Publication types

  • Case Reports

MeSH terms

  • Cyclophosphamide / therapeutic use
  • Dermatomyositis* / complications
  • Dermatomyositis* / diagnosis
  • Dermatomyositis* / drug therapy
  • Female
  • Humans
  • Middle Aged
  • Prognosis
  • Tacrolimus / therapeutic use
  • Thrombotic Microangiopathies* / complications
  • Thrombotic Microangiopathies* / etiology

Substances

  • Cyclophosphamide
  • Tacrolimus