• Shotaro Yamamoto, Takao Nagashima, Yoichiro Akiyama, Katsuya Nagatani, Masahiro Iwamoto, and Seiji Minota.
• Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Japan.
• Intern. Med. 2021 Oct 15; 60 (20): 3329-3333.

AbstractA 56-year-old woman presented with dermatomyositis positive for anti-melanoma differentiation-associated gene 5 antibody. No interstitial lung disease was detected. Despite treatment with methylprednisolone pulse therapy and cyclosporine, dysphagia developed. Furthermore, the presence of thrombocytopenia, elevated lactate dehydrogenase levels, and an undetectable haptoglobin level suggested the possibility of thrombotic microangiopathy (TMA). Disturbed consciousness developed shortly after TMA onset, and brain magnetic resonance imaging revealed hyperintensity lesions in the bilateral basal ganglia, thalami, and brainstem. The patient was diagnosed with atypical posterior leukoencephalopathy syndrome before dying of heart failure later that day. In conclusion, early TMA recognition and prompt intensive treatment are critical in such cases.

14 keywords...

hide…