J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website http://www.journalmc.org

Case Report

Volume 9, Number 12, December 2018, pages 394-399

Two-Year Treatment Tracking of Dermatomyositis Patient Complicated With Massive Pericardial Effusion and Stubborn Dysphagia: A Case Report and Literature Review

Figure 1. (a) On July 7, 2018, on admission, chest CT showed massive pericardial effusion. (b) On July 23, 2018, after treatment, pericardial effusion decreased significantly.

Figure 2. Trends in pericardial effusion and various indicators during treatment. Patients with a large amount of pericardial effusion, with the treatment gradually reduced, but in the late stage of the disease, secondary to difficult dysphagia, the relevant indicators change significantly, especially at 7.24. White blood cells, hematocrit and creatinine increased significantly, respiratory rate and blood pressure increased, and oxygen saturation decreased, posing a significant challenge to treatment, due to severe perfusion, suggesting that IVIG should be added promptly when patients have difficulty in swallowing. LVPW: left ventricular posterior wall; LVAW: anterior left ventricular wall; LVLW: left ventriculer lateral wall; EF: ejection fraction; PH: pulmonary hypertension; CPR: cardiopulmonary resuscitation; Alb: albumin; WBC: white blood cell; Cr: creatinine; HCT: hematocrit.

**Table 1.** Comparison of Related Indicators Before and After Treatment in 2 years
	May 31, 2016	July 19, 2016	July 11, 2017	July 7, 2018
AST: aspartate aminotransferase; CK: creatine kinase; cTnI: cardiac troponin I; CPR: cardio pulmonary resuscitation; ESR: equivalent series resistance; Alb: albumin; WBC: white blood cell; ECG: electrocardiograph; EMG: electromyography.
AST (U/L)	190	147	498	78	21	24	252	82
CK (IU/L)	2049	-	11,288	1,052	-	-	5,379	1,071
CK-MB (IU/L)	77	-	519	111	-	-	278	44
cTnI (µg/L)	-	0.01	-	-	-	-	0.523	1.117
hsCRP (mg/L)	10.09	-	3.18	8.42	5.22	3.3	9.02	33.15
ESR (mm/h)	26	-	4	-	14	-	6	-
Alb (g/L)	37.3	30.8	32.7	34.2	-	-	33.6	26.1
WBC (G/L)	10.35	-	6.11	10.91	6.87	6.43	4.89	19.27
ECG	Fast heart rate, low T wave	Normal	Fast heart rate	-	Normal	-	Myocardial infarction?	Myocardial infarction
Color ultrasound	-	-	Normal	-	-	-	Massive pericardial effusion	Pericardial effusion reduced
Rash	None	None	Scattered	Better	Cluster	Better	Facial erythema	Facial erythema
Muscle tenderness	Obvious	Better	Obvious	Better	Obvious	Better	None	None
Diarrhea	None	None	Diarrhea	Better	None	None	Diarrhea	Better
Dysphagia	None	None	None	None	None	None	None	Dysphagia
Sjogren	None	None	Sjogren	None	None	None	None	Sjogren
Pulmonary hypertension	None	None	None	None	None	None	None	Pulmonary hypertension
Muscle strength	Grade 4	Normal	Grade 3	Grade 3	Grade 4	Normal	Grade 4	Grade 3
EMG	-	-	Positive	-	-	-	-	-
Antibody positive	Anti-SSA/Ro 60 kD, anti-SSA/Ro 52 kD, anti-SmD1 weak	-	Anti-SSA/60 kD, anti-nRNP, anti-Sm weak	-	Anti-SSA/Ro 60 kD	-	-	-

Table 1. Comparison of Related Indicators Before and After Treatment in 2 years

May 31, 2016

July 19, 2016

July 11, 2017

July 7, 2018

Primitive

Therapy

Primitive

Therapy

Primitive

Therapy

Primitive

Therapy

AST: aspartate aminotransferase; CK: creatine kinase; cTnI: cardiac troponin I; CPR: cardio pulmonary resuscitation; ESR: equivalent series resistance; Alb: albumin; WBC: white blood cell; ECG: electrocardiograph; EMG: electromyography.

AST (U/L)

190

147

498

252

CK (IU/L)

2049

11,288

1,052

5,379

1,071

CK-MB (IU/L)

519

111

278

cTnI (µg/L)

0.01

0.523

1.117

hsCRP (mg/L)

10.09

3.18

8.42

5.22

3.3

9.02

33.15

ESR (mm/h)

Alb (g/L)

37.3

30.8

32.7

34.2

33.6

26.1

WBC (G/L)

10.35

6.11

10.91

6.87

6.43

4.89

19.27

ECG

Fast heart rate, low T wave

Normal

Fast heart rate

Normal

Myocardial infarction?

Myocardial infarction

Color ultrasound

Normal

Massive pericardial effusion

Pericardial effusion reduced

Rash

None

Scattered

Better

Cluster

Better

Facial erythema

Muscle tenderness

Obvious

Better

Obvious

Better

Obvious

Better

None

Diarrhea

None

Diarrhea

Better

None

Diarrhea

Better

Dysphagia

None

Dysphagia

Sjogren

None

Sjogren

None

Sjogren

Pulmonary hypertension

None

Pulmonary hypertension

Muscle strength

Grade 4

Normal

Grade 3

Grade 4

Normal

Grade 4

Grade 3

EMG

Positive

Antibody positive

Anti-SSA/Ro 60 kD, anti-SSA/Ro 52 kD, anti-SmD1 weak

Anti-SSA/60 kD, anti-nRNP, anti-Sm weak

Anti-SSA/Ro 60 kD