Efficacy of thalidomide in a girl with inflammatory calcinosis, a severe complication of juvenile dermatomyositisReport as inadecuate




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Pediatric Rheumatology

, 8:6

First Online: 04 February 2010Received: 05 March 2009Accepted: 04 February 2010

Abstract

We report a 14-year-old girl with juvenile dermatomyositis JDM complicated by severe inflammatory calcinosis successfully treated with thalidomide. She was diagnosed as JDM when she was 4 years old after a few months of increasing lethargy, muscle pain, muscle weakness, and rash. During three months, clinical manifestations and abnormal laboratory findings were effectively treated with oral prednisolone. However, calcinosis was recognized 18 months after disease onset. Generalized calcinosis rapidly progressed with high fever, multiple skin-subcutaneous inflammatory lesions, and increased level of CRP. Fifty mg-day 1.3 mg-kg day of oral thalidomide was given for the first four weeks, and then the dose was increased to 75 mg-day. Clinical manifestations subsided, and inflammatory markers had clearly improved. Frequent high fever and local severe pain with calcinosis were suppressed. The levels of FDP-E, IgG, and tryglyceride, which were all elevated before the thalidomide treatment, were gradually returned to the normal range. Over the 18 months of observation up to the present, she has had no inflammatory calcinosis, or needed any hospitalization, although established calcium deposits still remain. Her condition became painless, less extensive and less inflammatory with the CRP level below 3.08 mg-dL. Recent examination by whole-body 18F-FDG-PET-CT over the 15 months of thalidomide treatment demonstrated fewer hot spots around the subcutaneous calcified lesions.

Electronic supplementary materialThe online version of this article doi:10.1186-1546-0096-8-6 contains supplementary material, which is available to authorized users.

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Author: Takako Miyamae - Fumie Sano - Remi Ozawa - Tomoyuki Imagawa - Yoshiaki Inayama - Shumpei Yokota

Source: https://link.springer.com/



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