Dermatomyositis Associated with Hemophagocytic Syndrome: A Case Report/Review of the Literature

Hemophagocytic syndrome (HPS) is a disorder that might be transferred genetically due to an autosomal recessive genetic defect of the long arm of chromosome 9 and chromosome 10 (9q21.3-22 and 10q21-22), termed as primary hemophagocytic syndrome (PHPS) or familial hemophagocytic hemophagocytosis (FHPS) and it may be associated with a variety of infections, malignant neoplasms, drugs, autoimmune diseases and various immuno deficiencies, termed as secondary hemophagocytic syndrome (SHPS). For most patients with HPS, the outcome is rapid and fatal unless the diagnosis is made early and followed by prompt therapeutic intervention. Fever, hepatosplenomegaly, cytopenia, hypertriglyceridemia and/or hypofibrinogenemia, low erythrocyte sedimentation rate, hyperferritinemia, hyponatremia and hemophagocytosis shown in bone marrow, lymph nodes or spleen biopsy specimens constitute the clinical presentations of the syndrome. In this paper, a patient diagnosed with dermatomyositis associated with HPS is reported with the clinical findings of fever, lymph node enlargement, weakness and atrophy of proximal muscles, periorbital edema, skin thickness and symmetric violet erythema of the forearms. To our knowledge only two cases of dermatomyositis associated with HPS have been published in the medical literature. In addition, periorbital edema together with dermatomyositis is a very rare condition in the literature.

Dermatomyositis Associated with Hemophagocytic Syndrome: A Case Report/Review of the Literature

Hemophagocytic syndrome (HPS) is a disorder that might be transferred genetically due to an autosomal recessive genetic defect of the long arm of chromosome 9 and chromosome 10 (9q21.3-22 and 10q21-22), termed as primary hemophagocytic syndrome (PHPS) or familial hemophagocytic hemophagocytosis (FHPS) and it may be associated with a variety of infections, malignant neoplasms, drugs, autoimmune diseases and various immuno deficiencies, termed as secondary hemophagocytic syndrome (SHPS). For most patients with HPS, the outcome is rapid and fatal unless the diagnosis is made early and followed by prompt therapeutic intervention. Fever, hepatosplenomegaly, cytopenia, hypertriglyceridemia and/or hypofibrinogenemia, low erythrocyte sedimentation rate, hyperferritinemia, hyponatremia and hemophagocytosis shown in bone marrow, lymph nodes or spleen biopsy specimens constitute the clinical presentations of the syndrome. In this paper, a patient diagnosed with dermatomyositis associated with HPS is reported with the clinical findings of fever, lymph node enlargement, weakness and atrophy of proximal muscles, periorbital edema, skin thickness and symmetric violet erythema of the forearms. To our knowledge only two cases of dermatomyositis associated with HPS have been published in the medical literature. In addition, periorbital edema together with dermatomyositis is a very rare condition in the literature.

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  • Henter L-I. Diagnosis of a rapidly fatal childhood disease. Med Pediatr Oncol. 2002; 38(5): 305-9. 2. Henter J-I., Aricò M., Elinder G., Imashuku S., Janka G. Familial hemophagocytic lymphohistiocytosis (primary HLH). Hematol. Oncol. Clin. North Am. 1998 Apr; 12(2): 417-33. 3. Dofourcq-Lagelouse R, Jabado N, Le Deist F, Stephan J, Souillet G, Bruin M et al. Linkage of familial hemophagocytic lymphohistiocytosis to 10q21-22 and evidence for heterogeneity. Am J Hum Genet 1999; 64: 172-9.
  • Feldmann J, Callebaut I, Raposo G. Munc13-4 is essential for cytolytic granules fusion and is mutated in a form of familial hemophagocytic lymphohistiocytosis (FHL3). Cell 2003; 115: 461–73. 5. Menasche G, Feldmann J, Fischer A, de Sainte Basile G. Primary hemophagocytic syndromes point to a direct link between lymphocyte cytotoxicity and homeostasis. Immunol Rev 2005; 203: 165–79.
  • Kerevuer A, McIlroy D, Samri A. Up-regulation of adhesion and MHC molecules on splenic monocyte/macrophages in adult haemophagocytic syndrome. Br J Haematol 1999; 104: 871-7. 7. Ohadi M, Lalloz MR, Sham P. Localization of a gene for familial hemophagocytic lymphohistiocytosis at chromosome 9q21.3-22 by homozygosity mapping. Am J Hum Genet 1999; 64: 165–71.
  • Komp DM, McNamara J, Buckley P. Elevated soluble interleukin- 2 receptor in childhood hemophagocytic histiocytic syndrome. Blood 1989; 73: 2128-32.
  • Osugi Y, Hara J, Tagawa S. Cytokine production regulating Th1 and Th2 cytokines in hemophagocytic lymphohistiocytosis. Blood 1997; 89: 4100-3.
  • Takada H, Ohga S, Mizuno Y. Oversecretion of IL-18 in hemophagocytic lymphohistiocytosis: a novel marker of disease activity. Br J Haematol 1999; 106: 182-9.
  • Goransdotter Ericson K, Fadeel B, Nilsson-Ardnor S. Spectrum of perforin gene mutations in familial hemophagocytic lymphohistiocytosis. Am J Hum Genet 2001; 68: 590-7.
  • Feldmann J, Le Deist F, Ouachee-Chardin M. Functionalcon- sequences of perforin gene mutations in 22 patients with familial hemophagocytic lymphohistiocytosis. Br J Haematol 2002; 117: 965-72.
  • Ishii E, Ohga S, Imashuku S, Kimura N, Ueda I, Morimoto A et al. Review of hemophagocytic lymphohistiocytosis (HLH) in children with focus on Japanese experiences. Crit Rev Oncol Hematol 2005; 53(3): 209-23.
  • Henter J-I, Elinder G. Familial hemophagocytic
  • lymphohistiocytosis: clinical review based on the findings in seven children. Acta Paediatr Scand. 1991; 80: 269-77.
  • Wong KF, Hui DK, Chan JK, Chan YW, Ha SY. The acute lupus hemophagocytic syndrome, Ann Intern Med 1991; 114: 387-90.
  • Henter J-I, Arico M, Egeler M. HLH-94: a treatment protocol for hemophagocytic lymphohistiocytosis. Med Pediatr Oncol 1997; 28: 342-7.
  • Ambruso DR, Hays T, Zwartjes WJ, Tubergen DG, Favara BE. Successful treatment of lymphohistiocytic reticulosis with phagocytosis with epipodophyllotoxin VP 16-213. Cancer 1980; 45: 2516-20.
  • Henter J-I, Elinder G, Finkel Y, Söder O. Successful induction with chemotherapy including teniposide in familial erythrophagocytic lymphohistiocytosis. Lancet 1986; 2: 1402.
  • Fischer A, Cerf-Bensussan N, Blanche S. Allogeneic bone marrow transplantation for erythrophagocytic lymphohistiocytosis. J Pediatr 1986; 108: 267-70.
  • Stephan JL, Donadieu J, Le Deist F, Blanche S, Griscelli C, Fischer A. Treatment of familial hemophagocytic lymphohistiocytosis with antithymocyte globulins, steroids and cyclosporin A Blood 1993; 82: 2319-23.
  • Nespoli L, Locatelli F, Bonetti F. Familial hemophagocytic lymphohistiocytosis treated with allogeneic bone marrow transplantation. Bone Marrow Transplant 1991; 7: 139-142.
  • Janka G, Elinder G, Imashuku S, Schneider M, Henter J-I. Infection- and malignancy-associated hemophagocytic syndromes: secondary hemophagocytic lymphohistiocytosis. Hematol/Oncol Clin North Am 1998; 12: 435-444.
  • Imashuku S, Hibi S, Ohara T, Iwai A, Sako M, Kato M, Arakawa H et al. Effective control of Epstein-Barr virus-related hemophagocytic lymphohistiocytosis with immunochemotherapy. Blood 1999; 93: 186.
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: Yılda 6 Sayı
  • Yayıncı: TÜBİTAK
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