1991 Volume 14 Issue 2 Pages 122-130
To clarify the clinical features of acute interstitial pneumonia in dermatomyositis and polymyositis (DM/PM) patients with a poor prognosis, we examined retrospectively 18 patients of the acute interstitial pneumonia out of 71 patients of DM/PM. Ten out of 18 were patients with a poor prognosis, died of acute respiratory failure and the other 8 patients had a good prognosis. One out of 5 autopsied lungs in poor prognosis cases was cytomegalovirus pneumonia while the others were UIP. All the patients of poor prognosis had low CPK and low aldolase level, and showed less inflammatory signs than those with a good prognosis when their interstitial pneumonia occurred. All the male patients, 4 out of 18, were in a poor prognosis group. Typical skin rash such as heliotrope and Gottron's sign was more common in a poor prognosis group. Seven patients with poor prognosis showed interstitial pneumonia after steroid therapy to myositis and resistant to steroid pulse therapy, on the contrary all those who had a good prognosis showed interstitial pneumonia before or when myositis occurred. In addition, change of viral titers for Coxsakie virus were detected in some patients. These facts may provide the possibility that the interstitial pneumonia in poor prognosis patients is not the complication of DM/PM itself but a viral infection. There were no differences in specific autoantibody titers such as Jo-1 between good and poor prognosis patients. As for the chest X-ray film, in most cases of both groups interstitial pneumonia began from lower lungs and seemed difficult to predict the prognosis from the radiological findings.
