Treatment of MDA5-positive dermatomyositis complicated by gangrenous cholecystitis with tofacitinib

BackgroudDermatomyositis is a diffuse skeletal myositis disease with a variety of causes.The onset is mainly related to humoral immune abnormalities.Some therapeutic drugs,such as hormones and immunosu -ppressants,have poor therapeutic effects.In recent years, tofacitinib has been reported to be effective in the treatment of dermatomyositis.But there are many reports about the treatment of autoimmune diseases and infectious diseases with tofacitinib.Case presentationWe report a case of MDA5 antibody-positive dermatomyositis that was relieved after treatment with tofacitinib,during which gallbladder gangrene and suppurative cholecystitis occurred.After cholecystectomy,we continued to use tofacitinib and achieved good therapeutic effect. ConclusionsTofacitinib is effective in the treatment of MDA5 antibody-positive dermatomyositis,but the risk of infection is increased.It can still be used after infection control.A close follow-up should be performed during the use of tofacitinib.

Medical Image of the Month: Perforated Gangrenous Cholecystitis

No abstract available. Article truncated after 150 words. Clinical Scenario: A 47-year-old lady with a past medical history of hypertension, DVT on Xarelto, and methamphetamine use presented with a 3-day history of progressive right upper quadrant pain. Physical examination demonstrated marked right upper quadrant tenderness with palpation and significant rebound tenderness. A CT of the abdomen and pelvis without intravenous contrast demonstrated findings consistent with acute calculus cholecystitis with evidence of perforation and a pericholecystic abscess. The patient was taken emergently to the operating room where she underwent an open cholecystectomy which demonstrated perforated gangrenous cholecystitis with a large abscess in the gallbladder fossa. She was admitted to the ICU post-operatively due septic shock and did well with fluid resuscitation and antibiotic administration. Discussion: Acute cholecystitis is the most common acute complication of cholelithiasis and accounts for 3-9% of hospital admissions for acute abdominal pain. Eight to 95% of cases of acute cholecystitis are the result of a …