Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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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.
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.
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, 2016July 19, 2016July 11, 2017July 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)19014749878212425282
CK (IU/L)2049-11,2881,052--5,3791,071
CK-MB (IU/L)77-519111--27844
cTnI (µg/L)-0.01----0.5231.117
hsCRP (mg/L)10.09-3.188.425.223.39.0233.15
ESR (mm/h)26-4-14-6-
Alb (g/L)37.330.832.734.2--33.626.1
WBC (G/L)10.35-6.1110.916.876.434.8919.27
ECGFast heart rate, low T waveNormalFast heart rate-Normal-Myocardial infarction?Myocardial infarction
Color ultrasound--Normal---Massive pericardial effusionPericardial effusion reduced
RashNoneNoneScatteredBetterClusterBetterFacial erythemaFacial erythema
Muscle tendernessObviousBetterObviousBetterObviousBetterNoneNone
Pulmonary hypertensionNoneNoneNoneNoneNoneNoneNonePulmonary hypertension
Muscle strengthGrade 4NormalGrade 3Grade 3Grade 4NormalGrade 4Grade 3
Antibody positiveAnti-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---