Severity: Warning
Message: file_get_contents(https://...@gmail.com&api_key=61f08fa0b96a73de8c900d749fcb997acc09): Failed to open stream: HTTP request failed! HTTP/1.1 429 Too Many Requests
Filename: helpers/my_audit_helper.php
Line Number: 143
Backtrace:
File: /var/www/html/application/helpers/my_audit_helper.php
Line: 143
Function: file_get_contents
File: /var/www/html/application/helpers/my_audit_helper.php
Line: 209
Function: simplexml_load_file_from_url
File: /var/www/html/application/helpers/my_audit_helper.php
Line: 994
Function: getPubMedXML
File: /var/www/html/application/helpers/my_audit_helper.php
Line: 3134
Function: GetPubMedArticleOutput_2016
File: /var/www/html/application/controllers/Detail.php
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Function: pubMedSearch_Global
File: /var/www/html/application/controllers/Detail.php
Line: 488
Function: pubMedGetRelatedKeyword
File: /var/www/html/index.php
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Function: require_once
Background: Muscle involvement, termed polymyositis, is an uncommon manifestation of graft-versus-host disease (GvHD) in which the upper and lower limbs are commonly affected. However, respiratory failure due to diaphragmatic weakness has rarely been reported. Diagnosis is usually based on a combination of elevated muscle enzyme levels in the blood, neurophysiological studies, and muscle biopsies.
Case Report: A 23-year-old man who presented with Philadelphia chromosome (Ph)-positive chronic myeloid leukemia in myeloid blast crisis, underwent HLA-matched sibling (sister) hematopoietic stem cell transplantation. Six months post-transplant, he experienced bilateral arm pain and weakness, with an inability to raise his limbs against gravity. He was also unable to sit erect, and was dyspneic and hypoxic, thus requiring oxygen supplementation. Serum muscle enzyme levels were found to be markedly elevated. Magnetic resonance imaging showed a patchy hyperintense T2-weighted signal and enhancement in the muscle groups of the limbs, as well as in the psoas and erector spinae muscles. The electromyogram results were consistent with those of inflammatory myopathy. Muscle biopsy revealed extensive necrotizing myositis with extensive lymphocyte infiltration throughout the muscle fascicle. Additionally, fluorescence in situ hybridization (FISH) analysis demonstrated that 30% of the nuclei scored were in the muscle fibers of recipient XY origin, and 70% were in T-lymphocytes of donor XX origin. GvHD polymyositis was diagnosed, and the patient responded well to corticosteroids and extracorporeal photopheresis.
Conclusion: GvHD polymyositis can affect various muscle groups and results in various clinical presentations. In our case, truncal involvement resulting in an inability to sit erect was a unique presentation. Prompt diagnosis is important, and we have highlighted a comprehensive multimodal approach, including the potential use of FISH analysis, to aid in diagnosis.
Download full-text PDF |
Source |
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11620988 | PMC |
http://dx.doi.org/10.31547/bct-2023-040 | DOI Listing |
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