scholarly journals Symptoms persisting after hospitalization for COVID-19: 12 months interim results of the COFLOW study

2021 ◽  
Author(s):  
Martine Bek ◽  
Julia C Berentschot ◽  
Majanka Heijenbrok ◽  
Susanne Huijts ◽  
Michel E van Genderen ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Muscle Weakness ◽  
Length Of Hospital Stay ◽  
Female Gender ◽  
Severe Illness ◽  
Exertional Dyspnea ◽  
Persistent Symptoms ◽  
Memory Problems ◽  
Wide Range ◽  
Over Time

Introduction: A large proportion of patients experiences a wide range of sequelae after acute COVID-19 infection, especially after severe illness. The long-term health sequelae need to be assessed. Our objective was to longitudinally assess persistence of symptoms and clusters of symptoms up to 12 months after hospitalization for COVID-19, and to assess determinants of the main persistent symptoms. Methods: In this multicenter prospective cohort study patients with COVID-19 are followed up for 2 years with measurements at 3, 6, 12, and 24 months after hospital discharge. Here, we present interim results regarding persistent symptoms up to 12 months. Symptoms were clustered into physical, respiratory, cognitive and fatigue symptoms. Results: We included 492 patients; mean age was 60.2 years, 335 (68.1%) males, median length of hospital stay 11 days. At 3 months after discharge 97.0% of the patients had at least 1 persisting symptom, this declined to 95.5% and 92.0% at 6 and 12 months, respectively (p=0.010). Muscle weakness, exertional dyspnea, fatigue, and memory and concentration problems were the most prevalent symptoms with rates over 50% during follow-up. Over time, muscle weakness, hair loss, and exertional dyspnea decreased significantly (p<0.001), while other symptoms, such as fatigue, concentration and memory problems, anosmia, and ageusia persisted. Symptoms from the physical and respiratory cluster declined significantly over time, in contrast to symptoms from the fatigue and cognitive clusters. Female gender was the most important predictor of persistent symptoms and co-occurrence of symptoms from all clusters. Shorter hospital stay and treatment with steroids were related with decreased muscle weakness; comorbidity and being employed were related with increased fatigue; and shorter hospital stay and comorbidity were related with memory problems. Conclusion: The majority of patients experienced COVID-19 sequelae up to 12 months after hospitalization. Whereas physical and respiratory symptoms showed slow gradual decline, fatigue and cognitive symptoms did not evidently resolve over time. This finding stresses the importance of finding the underlying causes and effective treatments for post-COVID condition, beside adequate COVID-19 prevention.

scholarly journals Sex-Specific Long-Term Trends in Length of Hospital Stay, Postmenstrual Age at Discharge, and Survival in Very Low Birth Weight Infants

Neonatology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Matthias Fröhlich ◽  
Tatjana Tissen-Diabaté ◽  
Christoph Bührer ◽  
Stephanie Roll
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Hospital Stay ◽  
Very Low Birth Weight ◽  
Survival Rates ◽  
Length Of Hospital Stay ◽  
Mortality Rates ◽  
Vlbw Infants ◽  
Postmenstrual Age ◽  
Over Time

<b><i>Introduction:</i></b> In very low birth weight (&#x3c;1,500 g, VLBW) infants, morbidity and mortality have decreased substantially during the past decades, and both are known to be lower in girls than in boys. In this study, we assessed sex-specific changes over time in length of hospital stay (LOHS) and postmenstrual age at discharge (PAD), in addition to survival in VLBW infants. <b><i>Methods:</i></b> This is a single-center retrospective cohort analysis based on quality assurance data of VLBW infants born from 1978 to 2018. Estimation of sex-specific LOHS over time was based on infants discharged home from neonatal care or deceased. Estimation of sex-specific PAD over time was based on infants discharged home exclusively. Analysis of in-hospital survival was performed for all VLBW infants. <b><i>Results:</i></b> In 4,336 of 4,499 VLBW infants admitted from 1978 to 2018 with complete data (96.4%), survival rates improved between 1978–1982 and 1993–1997 (70.8 vs. 88.3%; hazard ratio (HR) 0.20, 95% confidence interval 0.14, 0.30) and remained stable thereafter. Boys had consistently higher mortality rates than girls (15 vs. 12%, HR 1.23 [1.05, 1.45]). Nonsurviving boys died later compared to nonsurviving girls (adjusted mean survival time 23.0 [18.0, 27.9] vs. 20.7 [15.0, 26.3] days). LOHS and PAD assessed in 3,166 survivors displayed a continuous decrease over time (1978–1982 vs. 2013–2018: LOHS days 82.9 [79.3, 86.5] vs. 60.3 [58.4, 62.1] days); PAD 40.4 (39.9, 40.9) vs. 37.4 [37.1, 37.6] weeks). Girls had shorter LOHS than boys (69.4 [68.0, 70.8] vs. 73.0 [71.6, 74.4] days) and were discharged with lower PAD (38.6 [38.4, 38.8] vs. 39.2 [39.0, 39.4] weeks). <b><i>Discussion/Conclusions:</i></b> LOHS and PAD decreased over the last 40 years, while survival rates improved. Male sex was associated with longer LOHS, higher PAD, and higher mortality rates.

Utility of Basal Laser Doppler Fluxmetry to Assess Resolution of Acute Vaso-Occlusive Episodes In Sickle Cell Disease

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4809-4809
Author(s):  
Patricia A. Shi ◽  
Olugbenga Olowokure ◽  
Crystal Miller
Keyword(s):  
Blood Flow ◽  
Hospital Stay ◽  
Sickle Cell ◽  
Linear Trend ◽  
Length Of Hospital Stay ◽  
Laser Doppler ◽  
History Of ◽  
Flow Improvement ◽  
Over Time ◽  
Time Point

Abstract Abstract 4809 Currently in the field of sickle cell research there are no widely accepted and easily measured means of assessing resolution of a vaso-occlusive episode other than a patient's pain rating, amount of narcotic usage, or length of hospital stay. An easily applicable method of blood flow measurement would therefore be extremely useful. Laser-Doppler fluxmetry is a non-invasive technology that uses the frequency shift of laser light striking moving blood cells for the determination of blood flow. In previous studies in sickle cell patients using this technology, patient-discomforting provocations such as response to transient ischemia, heating, or cold stimulus have been required to show a difference between sickle cell patients and controls, due to large intra-patient variability seen in basal steady-state readings (Bachir D et al, Microvasc Res 1993). However, this variability may be due to long time intervals (2-3 weeks in previous studies) between basal measurements with no confirmation that measurements were repeated in precisely the same anatomic location. Spatial precision is important since blood flow can differ between areas only 1 cm apart (Rodgers GP et al, N Engl J Med 1984). No study, to our knowledge, has yet used successive laser Doppler measurements, basal or provocative, within a hospitalization for a vaso-occlusive episode in order to correlate with its resolution. In this study, laser Doppler measurements (Periflux Model PF3 or PF5000, Perimed, Stockholm, Sweden) of the skin of the forehead and medial calf were assessed approximately every 8 hours from early in admission until hospital discharge in 8 subjects (6 females, 2 males) with SS or S ßthalassemia ranging in age from 10–35 (average 24, median 24) years enrolled in a Phase I clinical trial assessing intravenous immunoglobulin for treatment of acute vaso-occlusive episodes. Patients were normotensive, non-smoking, had no history of cardiovascular disease, no recent caffeine exposure, and no history of leg ulcers. The medial calf was chosen as a measurement site due to its clinical relevance in regard to leg ulcers and relative hairlessness. The forehead was chosen as a site due to report in the literature (in normal volunteers) of a relatively low (compared to other body sites) intra-individual coefficient of variation of 20% (Sundberg S, Scan J Clin Lab Invest 1984). Measurements over the length of the hospital stay were repeated in the precise same area (using a skin marker), with the subject in the supine position, using a 780 nm wavelength, 0.25 mm fiber separation, 1-cm diameter probe programmed to 34°C (to control for the inability to regulate room temperature in the standard inpatient units). Averaging absolute perfusion or blood cell velocity measurements from all evaluable subjects at each time point (number of measurements evaluable at each time point differed according to the number of patients still hospitalized at that time point), there was no linear trend of improvement in blood flow over time in either body location. When averaging percentage (%) change between two consecutive measurements from all evaluable subjects at each time point, there was also no linear trend in blood flow improvement over time. However, when averaging within each subject the % change between consecutive measurements for the length of that subject's hospital stay, all patients showed a positive % change in blood flow in both body locations. In the medial calf, the average and median improvement was 20% and 11% (range 5–52%). In the forehead, the average and median improvement was 37% and 18% (range 1–194%). We conclude that, despite efforts to mitigate possible circadian (Houben AJ et al, Scand J Clin Lab Invest 1994) and disease-related intra-individual patient variability, it is unlikely that basal laser Doppler flow measurements will be useful for real-time assessment of resolution of acute pain episodes. However, as all subjects showed an average % improvement in blood flow over the length of their hospital stay, basal laser Doppler measurements may still be useful as a research tool to compare the degree of blood flow improvement in a treatment versus control group for acute vaso-occlusive episodes. Its main potential advantage over pain ratings is greater objectivity; over narcotic usage greater independence from operator/provider bias; and over length of hospital stay greater resolution. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Neutralizing antibody responses over time in demographically and clinically diverse individuals recovered from SARS-CoV-2 infection in the United States and Peru: A cohort study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (12) ◽  
pp. e1003868
Author(s):  
Shelly Karuna ◽  
Shuying Sue Li ◽  
Shannon Grant ◽  
Stephen R. Walsh ◽  
Ian Frank ◽  
...  
Keyword(s):  
United States ◽  
Disease Severity ◽  
Disease Onset ◽  
Clinical Manifestations ◽  
The United States ◽  
Immune Defense ◽  
Severe Illness ◽  
Pseudotyped Virus ◽  
Wide Range ◽  
Over Time

Background People infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) experience a wide range of clinical manifestations, from asymptomatic and mild illness to severe illness and death, influenced by age and a variety of comorbidities. Neutralizing antibodies (nAbs) are thought to be a primary immune defense against the virus. Large, diverse, well-characterized cohorts of convalescent individuals provide standardized values to benchmark nAb responses to past SARS-CoV-2 infection and define potentially protective levels of immunity. Methods and findings This analysis comprises an observational cohort of 329 HIV–seronegative adults in the United States (n = 167) and Peru (n = 162) convalescing from SARS-CoV-2 infection from May through October 2020. The mean age was 48 years (range 18 to 86), 54% of the cohort overall was Hispanic, and 34% identified as White. nAb titers were measured in serum by SARS-CoV-2.D614G Spike-pseudotyped virus infection of 293T/ACE2 cells. Multiple linear regression was applied to define associations between nAb titers and demographic variables, disease severity and time from infection or disease onset, and comorbidities within and across US and Peruvian cohorts over time. nAb titers peaked 28 to 42 days post-diagnosis and were higher in participants with a history of severe Coronavirus Disease 2019 (COVID-19) illness (p < 0.001). Diabetes, age >55 years, male sex assigned at birth, and, in some cases, body mass index were also independently associated with higher nAb titers, whereas hypertension was independently associated with lower nAb titers. nAb titers did not differ by race, underlying pulmonary disease or smoking. Two months post-enrollment, nAb ID50 (ID80) titers declined 3.5 (2.8)-fold overall. Study limitations in this observational, convalescent cohort include survivorship bias and missing early viral loads and acute immune responses to correlate with the convalescent responses we observed. Conclusions In summary, in our cohort, nAb titers after SARS-CoV-2 infection peaked approximately 1 month post-diagnosis and varied by age, sex assigned at birth, disease severity, and underlying comorbidities. Our data show great heterogeneity in nAb responses among people with recent COVID-19, highlighting the challenges of interpreting natural history studies and gauging responses to vaccines and therapeutics among people with recent infection. Our observations illuminate potential correlations of demographic and clinical characteristics with nAb responses, a key element for protection from COVID-19, thus informing development and implementation of preventative and therapeutic strategies globally. Trial registration ClinicalTrials.gov NCT04403880.

Abstract WP315: Acute Myocardial Infarction Associated With Worse Outcomes in Acute Cerebrovascular Disease

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Sea mi Park ◽  
Shouri Lahiri ◽  
Asma Moheet ◽  
Jaspreet Mann ◽  
Axel Rosengart
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cerebrovascular Disease ◽  
Hospital Stay ◽  
Early Recognition ◽  
Hospital Costs ◽  
Care Facility ◽  
Length Of Hospital Stay ◽  
Female Gender ◽  
Nationwide Inpatient Sample Database

Introduction/Hypothesis: We examined the prevalence and outcomes of patients admitted with acute cerebrovascular disease (ACVD) and concomitant acute myocardial infarction (AMI). Methods: We utilized the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database (1998-2009) and identified 1,760,415 adult ACVD patients among 92,848,710 patients enrolled. Using SAS 6.4 and applying SPSS 22 the outcome variables mortality, length of hospital stay (LOS), hospital costs >$20,000, and disposition (home or any care facility) were selected and logistic regression analyses was performed adjusting for the covariates hypertension, diabetes mellitus, age, race, sex, number of comorbidities, and care complexity (numbers of inpatient procedures) among all ACVD with and without AMI. Results: Mean age was 71 years (SD 15) with 76% >65 years old; 54% female gender; 55% Whites, 11% Blacks, and 6% Hispanics. Among all ACVD, 66% had HTN, 28% DM, AMI 4.1%, LOS was 7.6 days (SD 9.8), in-patient mortality 12%; disposition home 42% and facility 44%, and mean hospital costs $36,010 (SD $63,331). After covariate adjustment, ACVD patients with AMI compared to those without AMI had a mortality of 30% vs 12% (P<0.000); LOS ≥7 days 53% vs 30% (P<0.000), facility discharge 68% vs 51% (P<0.000), and adjusted hospital costs 71% vs 44% (P<0.000). Conclusions: Acute myocardial infarction occurred in 4.1% of patients with acute cerebrovascular disease. It was associated with significantly increased risks of in-patient mortality, length of hospital stay, facility disposition and hospital costs. Considering the poor outcomes of ACVD patients with AMI may indicate more aggressive strategies for early recognition and reduction of myocardial injury.

scholarly journals Acute cardiovascular events in patients with community acquired pneumonia: results from the observational prospective FADOI-ICECAP study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Filippo Pieralli ◽  
◽  
Vieri Vannucchi ◽  
Carlo Nozzoli ◽  
Giuseppe Augello ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Stay ◽  
Cardiovascular Events ◽  
Length Of Hospital Stay ◽  
Severe Pneumonia ◽  
Female Gender ◽  
Community Acquired Pneumonia ◽  
Newly Diagnosed ◽  
Coronary Syndrome ◽  
New Onset

Abstract Background The burden of cardiovascular (CV) complications in patients hospitalised for community-acquired pneumonia (CAP) is still uncertain. Available studies used different designs and different criteria to define CV complications. We assessed the cumulative incidence of acute of CV complications during hospitalisation for CAP in Internal Medicine Units (IMUs). Methods This was a prospective study carried out in 26 IMUs, enrolling patients consecutively hospitalised for CAP. Defined CV complications were: newly diagnosed heart failure, acute coronary syndrome, new onset of supraventricular or ventricular arrhythmias, new onset hemorrhagic or ischemic stroke or transient ischemic attack. Outcome measures were: in-hospital and 30-day mortality, length of hospital stay and rate of 30-day re-hospitalisation. Results A total of 1266 patients were enrolled, of these 23.8% experienced at least a CV event, the majority (15.5%) represented by newly diagnosed decompensated heart failure, and 75% occurring within 3 days. Female gender, a history of CV disease, and more severe pneumonia were predictors of CV events. In-hospital (12.2% vs 4.7%, p < 0.0001) and 30-day (16.3% vs 8.9%, p = 0.0001) mortality was higher in patients with CV events, as well as the re-hospitalisation rate (13.3% vs 9.3%, p = 0.002), and mean hospital stay was 11.4 ± 6.9 vs 9.5 ± 5.6 days (p < 0.0001). The occurrence of CV events during hospitalisation significantly increased the risk of 30-day mortality (HR 1.69, 95% CI 1.14–2.51; p = 0.009). Conclusion Cardiovascular events are frequent in CAP, and their occurrence adversely affects outcome. A strict monitoring might be useful to intercept in-hospital CV complications for those patients with higher risk profile. Trial registration NCT03798457 Registered 10 January 2019 - Retrospectively registered

scholarly journals Characterization of Acute Poisoning in Hospitalized Children in Southwest China

2021 ◽  
Vol 9 ◽  
Author(s):  
Zhu Li ◽  
Li Xiao ◽  
Lin Yang ◽  
Shaojun Li ◽  
Liping Tan
Keyword(s):  
Hospital Stay ◽  
Southwest China ◽  
Population Distribution ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
Acute Poisoning ◽  
Living Environment ◽  
Hospitalized Children ◽  
Poisoning In Children ◽  
Over Time

Objective: Acute poisoning in children is characterized by regional differences. This study described the basic situation of childhood poisoning in southwest China based on hospitalized cases.Data and Methods: A total of 1,076 acute poisoning cases among hospitalized children admitted to Children's Hospital of Chongqing Medical University from January 2012 to December 2020 were included in this study. Clinical data such as gender, age, living environment, poisonous substance, and cause of poisoning were statistically described. Trends of length of hospital stay, population distribution, poisonous substances, and causes of acute poisoning in the hospitalized children were compared over time.Results: The cohort comprised 588 males and 488 females; 811 cases lived in rural areas and the rest resided in urban areas. Most cases were between early childhood and school age. Poisoning usually occurred at home (973 cases, 90.4%). Pesticides (381 cases, 35.4%) and drugs (275 cases, 25.6%) were the two most common poisonous substances. Two main causes of poisoning were accidental taking (755 cases, 70.2%) and suicide (177 cases, 16.4%). The results of univariate analysis of suicide showed significant correlations among gender, place of residence, age, poisonous substance, and place of suicide (P &lt; 0.001), while living environment (town), age (adolescence), and poisonous substance (pesticide, drug) were independent risk factors (P &lt; 0.05). There was no significant change in the length of hospital stay for poisoning over time. The overall number of hospitalizations presented a decreasing trend, while the number of urban children gradually increased. The proportion of adolescent poisoned children and suicidal children increased in the last 3 years.Conclusion: Optimizing the package and distribution channels of pesticides and drugs, raising safety awareness of children to avoid accidental injuries, and paying attention to children's mental health are measures that are necessary to prevent poisoning in children.

scholarly journals Course of long COVID symptoms over time in the ComPaRe long COVID prospective e-cohort

2021 ◽  
Author(s):  
Viet-Thi Tran ◽  
Raphael Porcher ◽  
Isabelle Pane ◽  
Philippe Ravaud
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Burden Of Disease ◽  
Prospective Cohort ◽  
Disease Onset ◽  
High Burden ◽  
Persistent Symptoms ◽  
Memory Problems ◽  
The People ◽  
Day By Day ◽  
Over Time

Abstract About 10% of the people infected by the severe acute respiratory syndrome coronavirus 2 are reported to experience “long COVID,” that is, persistence of symptoms several weeks after infection. Day-by-day prevalence of long COVID symptoms was determined from responses to the Long COVID Symptom Tool by 837 patients (3075 person-months) with a confirmed infection and enrolled in the ComPaRe long COVID cohort, a prospective cohort of such patients in France. Nine months after disease onset, 88.7% patients reported persistent symptoms and 70% reported a high burden of disease. Over time, the prevalence progressively decreased for 19/53 symptoms (e.g., loss of taste/smell) and was stable for 29/53 symptoms (e.g., fatigue). For 5/53 symptoms (e.g., memory problems), prevalence increased rapidly over the first two months and then reached a plateau. These findings are important for understanding the underlying etiologies and mechanisms of long COVID.

Incidence of diabetic ketoacidosis in newly diagnosed type 1 diabetes children in western Saudi Arabia: 11-year experience

2019 ◽  
Vol 32 (8) ◽  
pp. 857-862 ◽  
Author(s):  
Adnan Al Shaikh ◽  
Fayssal Farahat ◽  
Mohammad Saeedi ◽  
Ayman Bakar ◽  
Amal Al Gahtani ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Saudi Arabia ◽  
Hospital Stay ◽  
Diabetic Ketoacidosis ◽  
Length Of Hospital Stay ◽  
Developed Countries ◽  
Newly Diagnosed ◽  
Awareness Campaigns ◽  
Wide Range

Abstract Background A wide range of reports on the incidence of diabetic ketoacidosis (DKA) at the onset of type 1 diabetes mellitus (T1DM) in children have been published worldwide. Reports from Saudi Arabia are limited. The aim of this study was to assess the incidence, clinical pattern and severity of DKA in children with newly diagnosed T1DM and the association of autoimmune conditions with initial DKA occurrence at King Abdulaziz Medical City – Jeddah. Methods This retrospective chart review was conducted during the period 2005–2015. All newly diagnosed T1DM children during the study period were investigated (n = 390). Data were collected on the demographic characteristics, body mass index (BMI), DKA severity, length of hospital stay and follow-up data on the type of diabetes therapy. Results The incidence of DKA among newly diagnosed T1DM pediatric patients was 37.7% (n = 147). Moderate and severe DKA cases were significantly higher among female children (p = 0.04). Patients diagnosed with DKA had lower BMI (20.87 ± 5.21) than their counterparts (p = 0.03). The median length of hospital stay was higher among severe DKA compared to moderate and mild cases (5.0, 4.5 and 4.0 days, respectively). Conclusions The incidence of DKA among newly diagnosed T1DM is still high compared to developed countries; however, it is relatively lower than previous reports in Saudi Arabia. Immediate interventions, such as awareness campaigns, are vital to reduce the burden of this preventable health sequela among children with DM.

Is there a ‘weekend effect’ in elective lower limb arthroplasty?

2021 ◽  
Vol 103 (2) ◽  
pp. 110-113
Author(s):  
M Higgins ◽  
J Nightingale ◽  
K Sehat
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Lower Limb ◽  
Length Of Hospital Stay ◽  
Multiple Linear Regression Model ◽  
Female Gender ◽  
Weekend Effect ◽  
Hip Replacements ◽  
American Society ◽  
Knee And Hip Arthroplasty

Introduction The weekend effect has been defined as a real or perceived decline in patient care provided on weekends and that provided on weekdays. The primary aim of this study was to investigate the association between day of surgery and length of stay for patients receiving elective lower limb joint arthroplasty in a large NHS teaching hospital. Materials and methods Data were obtained from a prospectively collected database of consecutive patients undergoing elective primary total knee and hip arthroplasty. Patient and clinical variables were collected alongside length of hospital stay. Data were anonymised and analysed using a multiple linear regression model. Results A total of 3,544 knee and 3,277 hip replacements were included. No association was found between length of stay and day of surgery for either procedure. A significant association was noted between longer length of stay and increasing age, higher American Society of Anesthesiologists grade and male compared with female gender. Discussion No evidence of a weekend effect was identified. Certain patient factors predicted longer hospital stay and focussing additional resources on these patient groups may prove a useful strategy in reducing overall length of stay. Conclusions Length of stay reduced across the time period included in this review while maintaining equality between the days of the week, which represents the successful management of weekend services.

scholarly journals Anti-Ku Antibody-Positive Myositis Presenting as a Wide Range of Axial Myopathies and Myocarditis: A Case Report and Review of the Literature

2021 ◽  
Author(s):  
Masanori Kono ◽  
Toshihiko Komai ◽  
Hayato Yuki ◽  
Norio Hanata ◽  
Toshiyuki Kakumoto ◽  
...  
Keyword(s):  
Muscle Weakness ◽  
Connective Tissue Diseases ◽  
Japanese Woman ◽  
Resonance Imaging ◽  
Exertional Dyspnea ◽  
Muscle Involvement ◽  
Antibody Staining ◽  
Wide Range ◽  
Magnetic Resonance Imaging Mri ◽  
Negative Magnetic Resonance Imaging

Abstract Idiopathic inflammatory myopathies (IIMs) are autoimmune diseases predominantly affecting proximal muscles; paraspinal muscle involvement is relatively rare. Because paraspinal myopathies do not always cause clinically-evident symptoms, the diagnosis of IIMs with axial myopathies can be challenging. Anti-Ku autoantibodies, initially reported in polymyositis/systemic sclerosis overlap syndrome, are myositis-associated antibodies (MAAs) observed in patients with a wide variety of connective tissue diseases (CTDs). Few reports have been published demonstrating predominant axial myopathy in IIM patients with anti-Ku antibodies. Herein, we investigated a previously healthy Japanese woman in her early 70s who presented with Raynaud’s phenomenon, back pain, and exertional dyspnea. The creatine kinase (CK) was elevated and antinuclear antibody staining was positive, but myositis-specific antibodies (MSAs) were negative. Magnetic resonance imaging (MRI) revealed myocarditis and a wide range of axial muscle inflammation, including bilateral thoracolumbar paraspinal, infraspinatus, and trapezius muscles. The muscle biopsy was consistent with IIM. In addition, anti-Ku antibody was positive. Administration of prednisolone and tacrolimus quickly alleviated the symptoms and the CK level returned to normal. The diagnosis of IIM was arduous in this case because she did not present with camptocormia, muscle weakness involving the proximal limbs was not apparent, and MSAs were negative. Whether axial myopathy and myocarditis are more prevalent in IIM patients with than without anti-Ku antibodies is uncertain. Clinicians should suspect axial myopathy and MAAs, such as anti-Ku antibodies, especially in patients in whom muscle weakness of the proximal limbs is not noticeable.

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