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1 Dept of Respiratory Medicine, 2 Dept of Pathology, 3 Dept of Radiology, Louis Pradel Hospital, Claude Bernard University, Lyon, 4 Dept of Thoracic Surgery, Sainte-Marguerite Hospital, Marseille, 5 Dept of Respiratory Medicine, Tenon Hospital, Paris, and 6 Dept of Respiratory and Cardiology Medicine, Pontchaillou Hospital, Rennes, France
CORRESPONDENCE: J-F. Cordier, Groupe d'Etudes et de Recherche sur les Maladies "Orphelines" Pulmonaires, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, 69394 Lyon Cedex 03, France. Fax: 33 472357653. E-mail: germop@univ-lyonl.fr
Keywords: dermatomyositis, fibrosis, interstitial pneumonia, nonspecific
Received: March 10, 2003
Accepted April 22, 2003
This work was supported by a grant from Hospices Civils de Lyon, Programme Hospitalier de Recherche Clinique, France (93.97-005).
This study investigated interstitial pneumonia associated with amyopathic dermatomyositis, dermatomyositis and polymyositis, paying particular attention to muscular and/or cutaneous manifestations and their chronology relative to lung involvement. Patients included four males and 13 females, aged 51.7±10.8 yrs, who had surgical lung biopsy.
Diagnoses included dermatomyositis (10 patients), polymyositis (four patients) and amyopathic dermatomyositis (three patients). Solitary respiratory manifestations preceded the onset of any skin or muscle disease in four cases (24%). Reticular and ground glass opacities were the most frequent computed tomography (CT) findings. Pathological review showed nonspecific interstitial pneumonia (eleven, 65%; cellular, two; cellular and fibrotic, five; fibrotic, four), usual interstitial pneumonia (two), organising pneumonia (two), lymphocytic interstitial pneumonia (one), and unclassifiable interstitial pneumonia (one). Nonspecific interstitial pneumonia was the most common histological pattern of interstitial pneumonia in patients with amyopathic dermatomyositis (three of three) and in patients with respiratory symptoms as the initial clinical manifestation of the connective tissue disease (three of four). Survival at 5 yrs was 50%.
This study shows the clinician should remain alert to potential muscular or cutaneous manifestations whenever a pathological diagnosis of nonspecific interstitial pneumonia is made.
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