QJM: An International Journal of Medicine, 2016, 205–206 doi: 10.1093/qjmed/hcv196 Advance Access Publication Date: 10 October 2015 Clinical picture
CLINICAL PICTURE
Improvement of the nailfold capillaroscopy after immunosuppressive treatment in polymyositis 68%). At this point, we performed a nailfold capillaroscopy that showed widespread capillary hemorrhages and megacapillaries (Figure 1 and Supplementary Appendix S1). Once polymyositis diagnosis was established, the patient was started on monthly intravenous immune globulin, azathioprine and oral prednisone 1 mg/kg per day that was slowly tapered during 1 year to 5 mg daily. One year after the initial evaluation there was not periungeal erythema, power in all muscle groups was 5/5 and both pulmonary function tests and muscle enzymes were normal. A follow-up capillaroscopy showed a marked improvement of the microvascular involvement with resolution of the megacapillaries and the hemorrhages (Figure 1, Supplementary Appendix S1 and video). Nailfold capillaroscopy is a non-invasive method to assess skin microvasculature mainly used to discriminate primary
Figure 1. Nailfold capillaroscopy improvement after immunosupressive treatment. Fourth finger nailfold capillaroscopy performed (A) before immunosuppressive treatment showing megacapillaries (black arrow) and hemorrhages (black arrow tip). Fourth finger nailfold capillaroscopy repeated (B) one year after immunosuppressive treatment showing tortuosities (white arrow) and ramifications (white arrow tip).
C The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. V
All rights reserved. For Permissions, please email: [email protected]
205
Downloaded from by guest on March 17, 2016
A 74-year-old woman with history of Raynaud phenomenon started 10 years ago, vitiligo and Graves-Basedow disease treated at age 53 years with radioactive iodine, presented to the Department of Internal Medicine of the Vall d’Hebron University Hospital in January 2014, with 4 months of progressive muscle weakness. She also had dyspnea on exertion and weight loss. On examination she had prominent neck flexor weakness and mild proximal arm weakness with periungueal erythema. Blood tests showed increased levels of creatine kinase (472 UI/l, normal range
CLINICAL PICTURE
Improvement of the nailfold capillaroscopy after immunosuppressive treatment in polymyositis 68%). At this point, we performed a nailfold capillaroscopy that showed widespread capillary hemorrhages and megacapillaries (Figure 1 and Supplementary Appendix S1). Once polymyositis diagnosis was established, the patient was started on monthly intravenous immune globulin, azathioprine and oral prednisone 1 mg/kg per day that was slowly tapered during 1 year to 5 mg daily. One year after the initial evaluation there was not periungeal erythema, power in all muscle groups was 5/5 and both pulmonary function tests and muscle enzymes were normal. A follow-up capillaroscopy showed a marked improvement of the microvascular involvement with resolution of the megacapillaries and the hemorrhages (Figure 1, Supplementary Appendix S1 and video). Nailfold capillaroscopy is a non-invasive method to assess skin microvasculature mainly used to discriminate primary
Figure 1. Nailfold capillaroscopy improvement after immunosupressive treatment. Fourth finger nailfold capillaroscopy performed (A) before immunosuppressive treatment showing megacapillaries (black arrow) and hemorrhages (black arrow tip). Fourth finger nailfold capillaroscopy repeated (B) one year after immunosuppressive treatment showing tortuosities (white arrow) and ramifications (white arrow tip).
C The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. V
All rights reserved. For Permissions, please email: [email protected]
205
Downloaded from by guest on March 17, 2016
A 74-year-old woman with history of Raynaud phenomenon started 10 years ago, vitiligo and Graves-Basedow disease treated at age 53 years with radioactive iodine, presented to the Department of Internal Medicine of the Vall d’Hebron University Hospital in January 2014, with 4 months of progressive muscle weakness. She also had dyspnea on exertion and weight loss. On examination she had prominent neck flexor weakness and mild proximal arm weakness with periungueal erythema. Blood tests showed increased levels of creatine kinase (472 UI/l, normal range
![[Nailfold capillaroscopy].](/assets/img/hold.png)
