Document 0296
 DOCN  M9590296
 TI    Clinical features and longterm follow-up of autoimmune polymyositis in
       HIV infection.
 DT    9509
 AU    Gala S; Garcia R; Brew B; Stewart G; Department of Immunology, Westmead
       Hospital.
 SO    Annu Conf Australas Soc HIV Med. 1994 Nov 3-6;6:212 (unnumbered
       abstract). Unique Identifier : AIDSLINE ASHM6/95291803
 AB    A 44 year old HIV-positive male was admitted in May 1992 for
       investigation of progressive muscular weakness and rising serum creatine
       phosphokinase (CPK). Symptoms of muscular weakness had developed over
       the preceding 2 months, and were accompanied by myalgia, lethargy,
       fatigue and malaise. Proximal myopathy was demonstrable on physical
       examination. CPK had been rising progressively over the preceding 8
       months, and on admission was 2,776 IU/L (normal range 24-204); a change
       in anti-retroviral therapy from Zidovudine to Didanosine in February
       1992 had failed to halt the progressive rise. CD4 and CD8 counts were
       270/mm3 (9%) and 2,220/mm3 (75%), respectively. Electromyography
       demonstrated polyphasic compound muscle action potentials and
       spontaneous fibrillation, consistent with myopathy. Muscle biopsy
       revealed myofibre necrosis and an intense interstitial mononuclear
       inflammatory cell infiltrate, indicative of autoimmune polymyositis.
       Response to moderate-dose oral corticosteroid therapy (Prednisolone 0.5
       mg/kg/d) was dramatic, with complete resolution of clinical and
       biochemical abnormalities within 1 week. Despite 2 years of continuous
       therapy, the disease has failed to enter a phase of spontaneous
       remission, and the patient has become dependent on corticosteroids for
       adequate clinical and biochemical control; several attempts at
       withdrawal of Prednisolone have resulted in acute flare of disease
       activity. This and other similar cases to be discussed illustrate
       several features that distinguish the HIV-related form of autoimmune
       polymyositis: i) occurrence in a younger age group; ii) absence of
       extra-rheumatic disease manifestations; iii) correlation with CD8
       lymphocytosis; and iv) absence of autoantibody production.
 DE    Adult  Autoantibodies/ANALYSIS  Autoimmune
       Diseases/*DIAGNOSIS/IMMUNOLOGY/THERAPY  Biopsy  CD4-CD8 Ratio
       Diagnosis, Differential  Electromyography  Human  HIV
       Infections/*DIAGNOSIS/IMMUNOLOGY/THERAPY  Male  Muscles/PATHOLOGY
       Polymyositis/*DIAGNOSIS/IMMUNOLOGY/THERAPY  Prednisolone/ADMINISTRATION
       & DOSAGE  MEETING ABSTRACT

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