A woman in her 20s was admitted to the intensive care unit of our hospital owing to the onset of severe dysphagia that required a nasogastric tube. Her symptoms had started 2 months previously with progressive myalgia, proximal muscle weakness, and fever followed by diffuse edema involving the face and extremities. Laboratory studies showed a peak creatine kinase level of 12 410 U/L (normal range, 26-240 U/L; to convert to microkatals per liter, multiply by 0.0167), an erythrocyte sedimentation rate of 66 (normal range, 1-20 mm/h), and a D-dimer level of 1639 μg/mL (normal range, <0.5 μg/mL; to convert to nanomoles per liter, multiply by 5.476). A screening autoimmune disease panel revealed positive results for antinuclear antibody (titer, 1:320; speckled granular pattern) and an anticardiolipin antibody level of 14 U/mL (normal range, <10 U/mL). Electromyography showed widespread acute muscle damage; deltoid muscle biopsy findings were consistent with necrotizing myopathy. Suspecting an autoimmune myopathy, we treated the patient with 4 sessions of γ-globulin intravenously (2 g/kg over a 5-day period) followed by oral prednisolone (65 mg/d) and mycophenolate mofetil (1000 mg twice a day), which had a partial benefit to her clinical conditions. After 2 months, she noticed worsening of her weakness and facial edema. In addition, she developed a violaceous eruption of the eyelids associated with small white spots on her face, chest, and arms.

一名20多岁的妇女因严重吞咽困难发作而需要进入鼻胃管，因此被送入我们医院的重症监护室。她的症状在2个月前开始，伴有进行性肌痛，近端肌无力和发烧，然后出现面部和四肢弥漫性水肿。实验室研究表明，肌酸激酶的峰值水平为12 410 U / L（正常范围为26-240 U / L；转换为微卡每升，乘以0.0167），红细胞沉降率为66（正常范围为1-20）毫米/小时），D-二聚体水平为1639μg/ mL（正常范围，<0.5μg/ mL;要转换为每升纳摩尔，乘以5.476）。筛查自身免疫性疾病小组显示抗核抗体（滴度为1：320；有斑点的颗粒状模式）的阳性结果和抗心磷脂抗体水平为14 U / mL（正常范围< 10 U / mL）。肌电图显示广泛的急性肌肉损伤。三角肌活检结果与坏死性肌病一致。怀疑自身免疫性肌病，我们对患者进行了4次γ-球蛋白静脉内治疗（5天期间2 g / kg），然后口服泼尼松龙（65 mg / d）和霉酚酸酯（每天两次1000 mg），这对她的临床状况有部分好处。2个月后，她注意到自己的无力和面部浮肿加重。另外，她的脸，胸部和手臂上的小白斑也引起了眼睑的紫罗兰性喷发。我们对患者进行了4次γ-球蛋白静脉内治疗（5天2 g / kg），然后口服泼尼松龙（65 mg / d）和霉酚酸酯（每天两次1000 mg）治疗，这部分受益适应她的临床情况。2个月后，她注意到自己的无力和面部浮肿加重。另外，她的脸，胸部和手臂上的小白斑也引起了眼睑的紫罗兰性喷发。我们对患者进行了4次γ-球蛋白静脉内治疗（5天期间2 g / kg），然后口服泼尼松龙（65 mg / d）和霉酚酸酯（每天两次1000 mg）治疗，这部分受益适应她的临床情况。2个月后，她注意到自己的无力和面部浮肿加重。另外，她的脸，胸部和手臂上的小白斑也引起了眼睑的紫罗兰性喷发。