In addition, a relatively low perfusion of the left lung was expected in our patient due to vascular resection during left upper lobectomy

In addition, a relatively low perfusion of the left lung was expected in our patient due to vascular resection during left upper lobectomy. dynamic breathing magnetic resonance imaging Introduction Clinically amyopathic dermatomyositis (CADM) is a type of dermatomyositis (DM) that is characterized by typical cutaneous manifestations of DM with little or no muscle abnormalities and accounts for an estimated 5-20% of all cases of DM (1). Antibodies against melanoma differentiation-associated protein 5 (MDA5) mark this subtype of dermatomyositis, and it Maackiain is reported to be associated with severe, progressive, and often fatal, interstitial Maackiain lung disease (ILD) (2,3). Typical computed tomography (CT) findings of ILD in CADM include bilateral distribution of reticular opacities, volume loss, bronchiectasis, and infiltration (4). We herein report a rare case of anti-MDA5 antibody-positive CADM complicated by unilateral ILD in a patient with a history of tumor resection in the left lung. Case Report A 78-year-old man with a history of left upper lobe lung cancer (pT2aN2M0, stage IIIA) and consequent left upper lobectomy had been followed for 5 years with no recurrence on CT imaging. He had been initially admitted to the Department of Urology in January 20XX for bladder cancer surgery and underwent three transurethral bladder tumor resection (TURBT) procedures. After the third procedure in late March, 20XX (day 1), he developed a persistent fever of unknown origin (body temperature more than 38) that was refractory to meropenem hydrate. Maackiain He also presented with chronic cough for a few months and subacute, worsening dyspnea on exertion. In addition, an abnormal opacity in the chest region noted on CT imaging appeared to be progressing, and he was referred to our department on day 35, for a further investigation and management. His medical history included chronic obstructive pulmonary disease, type 2 diabetes mellitus, and hypertension. He was an ex-smoker (52 pack years until he quit at 72 years old) and had been chronically exposed to asbestos (between 40-65 years old). His regular medications were miglitol, sitagliptin phosphate, and telmisartan. On admission to our service, vital signs were normal except for a slight fever of 37.6 and an oxygen saturation of 100% with 2 L/min oxygen via nasal cannula. H3 A physical examination revealed fine crackles in the middle to lower lung fields at the back of the right lung along with decreased breath sounds in the left lung. On inspection, movement of the remaining chest wall experienced decreased more seriously than that of the right chest wall. The patient experienced skin lesions and symptoms characteristic of dermatomyositis, namely Gottron’s papule, dorsal dermal sclerosis, peripheral cyanosis, ulcerations and peripheral atrophy of fingers, erythema of the toenail mattresses (periungual erythema; Fig. 1), Raynaud’s trend, and morning tightness. He did not complain of muscle mass weakness or myalgia, and manual muscle mass testing of the extremities was normal. Open in a separate window Number 1. Physical findings. (A) Pores and skin lesion on the right hand including Gottrons papule and peripheral atrophy. (B) Cyanosis of the fingers of the left hand. The laboratory findings are demonstrated in Table 1 and were significant for elevated levels of aldolase (8.3 IU/L), ferritin (253 ng/mL), Krebs von den Lungen (KL-6) (1,133 U/mL), and inflammatory markers-namely C-reactive protein (9.16 mg/dL) and WBC (10,220 /L); however, the creatine kinase level was Maackiain normal. An arterial blood gas analysis was remarkable only for improved A-aDO2 (21 Torr, space air flow). Immunological investigations were positive for anti-nuclear antibodies, notably a cytoplasmic pattern (1:40), along with anti-MDA5 antibody (titer: 189 index value; normally 32.0, determined using an enzyme-linked immunosorbent assay; MEASACUP anti-MDA5 test, Corona Electric, Hitachinaka, Japan). Pulmonary function checks shown restriction and diffusion impairment. Table 1. Laboratory Test Results. Total blood countImmunologyWBC10,220/LRF9IU/mLHb9.8g/dLAnti-CCP antibody-Plt347103/LAnti-nuclear antibody1:40NUCLEOLAR1:40Blood ChemistryCYTOPLASMIC1:40AST61IU/LAnti-Jo-1 antibody-ALT22IU/LAnti-U1-RNP antibody-LDH335IU/LAnti-Sm antibody-CK82U/LAnti-SS-A antibody-Aldolase8.3IU/LAnti-SS-B antibody-TP6.5g/dLAnti-ds-DNA antibody-Albumin2.7g/dLAnti-Scl-70 antibody-Na132mEq/LPR3-ANCA-K4.4mEq/LMPO-ANCA-BUN14mg/dLAnti-centromere antibody-Cre1.19mg/dLAnti-RNA polymerase III antibody-CRP9.16mg/dLAnti-ARS antibody-ESR (1 h)82mmAnti-Mi-2 antibody-KL-61,133U/mLAnti-Ku antibody-SP-D33.2ng/mLAnti-PM-Scl100 antibody-Ferritin253ng/mLAnti-SRP antibody-Anti-Jo-1 antibody-Arterial blood gas analysis (room air)Anti-PL-7 antibody-pH7.38Anti-PL-12 antibody-PaCO238TorrAnti-OJ antibody-PaO282TorrAnti-EJ antibody-HCO3?24mmol/LAnti-Ro-52 antibody-A-aDO221TorrAnti-TIF1- antibody-Anti-MDA-5 antibody189 Open in a separate windowpane WBC: white blood cell, Hb: hemoglobin, Plt: platelets, AST: aspartate transaminase, ALT: alanine transaminase, LDH: lactate dehydrogenase, CK: creatine kinase, TP: total protein, BUN: blood urea nitrogen, Cre: creatinine, ESR: erythrocyte sedimentation rate, KL-6: Krebs von den Lungen-6, SP-D: surfactant protein D, RF: rheumatoid element, anti-MDA5 antibody: normal index value 32.0 Chest X-ray acquired immediately after transfer to our department revealed unilateral ground-glass opacity and reticulation in the right middle and lower lung fields (Fig. 2A). Subsequent high-resolution CT of the right lung showed prevailing.