Abstract
A 66-year-old man visited with the chief complaints of proximal muscle pain and fatigue. He was diagnosed with dermatomyositis (DM) by further evaluation. We started the administration of prednisolone (PSL) 70 mg/day (1 mg/kg/day). After a short time of PSL administration, black stool, hemoglobin reduction and thrombocytopenia were observed. Esophagogastroduodenoscopy (EGD) revealed multiple shallow ulcers in the gastric antrum and duodenum. Cytomegalovirus (CMV) antigen (C7-HRP) was slightly positive, but no giant cells or inclusion bodies were detected in the biopsy tissue from the ulcer. However, CMV gastroenteritis was strongly suspected, which led to the start of ganciclovir and γ-globulin administration. Later, CMV DNA-PCR in the peripheral and bone marrow blood at the time of the first gastrointestinal bleeding turned out to be positive. The CMV antigen, CMV DNA-PCR, and endoscopic findings improved. He was discharged but thrombocytopenia and hemoglobin reduction were prolonged. So, we retried bone marrow puncture in clinic. There was dysplasia in multiple lineages and fewer than 5% blast cells in the bone-marrow aspiration sample. He was diagnosed with myelodysplastic syndrome (MDS). Although many case reports of autoimmune diseases associated with MDS have been reported, dermatomyositis associated with MDS is very rare. We report the case of dermatomyositis associated with myelodysplastic syndrome, accompanying intractable gastrointestinal bleeding due to cytomegalovirus gastroenteritis.
