Aids e miopatia relato de um caso e revisão da literatura

Rodrigues, Káris M. de Pinho; Puccioni-Sohler, Marzia; Castineiras, Terezinha M. P. P.; Pereira, Marisa T.; Papi, J. Angelo; Schechter, Mauro; Ávila, Cláudio; Duarte, Francisco; Novis, Sérgio A. P.

doi:10.1590/S0004-282X1991000300022

Resumos

É relatado o caso de um paciente com miopatia de apresentação clínica incomum como manifestação inicial da infecção por HIV. O paciente apresentava aumento de volume dos membros acompanhado de sinais flogísticos e elevação dos níveis séricos de enzimas musculares. A alteração histopatológica predominante consistia em necrose segmentar de fibrocélulas musculares esqueléticas. Evoluiu com pneumonia por Pneumocystis carinii, tratada satisfatoriamente com sulfametoxazol e trimetropim. Apesar do uso sucessivo de indometacina, prednisona e dexametasona, a miopatia continuava a progredir. Após administração de methotrexate, houve regressão do quadro neurológico.

Report of an unusual case of myopathy in an HIV infected patient, responsive only to the immunossupressor drug methothexate. The patient was a 39 year old homosexual male with no past history of HIV-related manifestations. One month prior to admission he noticed that his left thigh was swollen and painful. Two weeks later both arms became enlarged and tender. A few days before admission he noticed intermitent fever and progressive dyspnea. Upon admission, oral thrush, dyspnea and global enlargment of both arms was noted. There was no articular involvement. Fiberoptic broncoscopy revealed Pneumocystis carinii pneumonia (PCP). Serology for HIV was positive. Tests for antinuclear antibodies were negative. Serum CPK level was 1019 IU. Capillaroscopy was compatible with vasculitis. Muscle biopsy revealed multifocal myonecrosis. PCP was successfully treated with standard doses of TMP/SMZ. Although indomethacin, prednisone and dexamethasone were administered in succession, there was relentless progression of myopathy and persistence of fever. Six days after administration of methotrexate, the patient defervesced, volume of arms and legs diminished. CPK levels returned to normal after a second course of methotrexate. Upon reduction of the dose thigh enlargement recrudesced. The patient remained asymptomatic on weekly doses of methothexate. He died five months later of acute respiratory failure.

CONTENTS CONTEÚDO

Káris M. de Pinho Rodrigues^I; Marzia Puccioni-Sohler^II; Terezinha M. P. P. Castineiras^I; Marisa T. Pereira^I; J. Angelo Papi^III; Mauro Schechter^I; Cláudio Ávila^III; Francisco Duarte^IV; Sérgio A. P. Novis^II

^IInfectologista - Trabalho realizado pelos Serviços de Doenças Infecciosas e Parasitárias (DIP), Neurologia, Imunologia e Neuropatologia do Hospital Universitário Clementino Fraga Filho (HUCFF) da Universidade Federal do Rio de Janeiro (UFRJ)

^IINeurologista - Trabalho realizado pelos Serviços de Doenças Infecciosas e Parasitárias (DIP), Neurologia, Imunologia e Neuropatologia do Hospital Universitário Clementino Fraga Filho (HUCFF) da Universidade Federal do Rio de Janeiro (UFRJ)

^IIIImunologista - Trabalho realizado pelos Serviços de Doenças Infecciosas e Parasitárias (DIP), Neurologia, Imunologia e Neuropatologia do Hospital Universitário Clementino Fraga Filho (HUCFF) da Universidade Federal do Rio de Janeiro (UFRJ)

^IVNeuropatologista - Trabalho realizado pelos Serviços de Doenças Infecciosas e Parasitárias (DIP), Neurologia, Imunologia e Neuropatologia do Hospital Universitário Clementino Fraga Filho (HUCFF) da Universidade Federal do Rio de Janeiro (UFRJ)

RESUMO

É relatado o caso de um paciente com miopatia de apresentação clínica incomum como manifestação inicial da infecção por HIV. O paciente apresentava aumento de volume dos membros acompanhado de sinais flogísticos e elevação dos níveis séricos de enzimas musculares. A alteração histopatológica predominante consistia em necrose segmentar de fibrocélulas musculares esqueléticas. Evoluiu com pneumonia por Pneumocystis carinii, tratada satisfatoriamente com sulfametoxazol e trimetropim. Apesar do uso sucessivo de indometacina, prednisona e dexametasona, a miopatia continuava a progredir. Após administração de methotrexate, houve regressão do quadro neurológico.

SUMMARY

Report of an unusual case of myopathy in an HIV infected patient, responsive only to the immunossupressor drug methothexate. The patient was a 39 year old homosexual male with no past history of HIV-related manifestations. One month prior to admission he noticed that his left thigh was swollen and painful. Two weeks later both arms became enlarged and tender. A few days before admission he noticed intermitent fever and progressive dyspnea. Upon admission, oral thrush, dyspnea and global enlargment of both arms was noted. There was no articular involvement. Fiberoptic broncoscopy revealed Pneumocystis carinii pneumonia (PCP). Serology for HIV was positive. Tests for antinuclear antibodies were negative. Serum CPK level was 1019 IU. Capillaroscopy was compatible with vasculitis. Muscle biopsy revealed multifocal myonecrosis. PCP was successfully treated with standard doses of TMP/SMZ. Although indomethacin, prednisone and dexamethasone were administered in succession, there was relentless progression of myopathy and persistence of fever. Six days after administration of methotrexate, the patient defervesced, volume of arms and legs diminished. CPK levels returned to normal after a second course of methotrexate. Upon reduction of the dose thigh enlargement recrudesced. The patient remained asymptomatic on weekly doses of methothexate. He died five months later of acute respiratory failure.

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Dra. Marzia Puccioni-Sohler - Serviço de Neurologia, Hospital Universitário Clementino Fraga Filho, UFRJ - Av. Brigadeiro Trompowsky s/n - 21040 Rio de Janeiro RJ - Brasil.

1. Berman A, Espinoza LR, Diaz JD, Aguilar JL, Rolando T, Vazey FB, Germain BF, Loekey RF. Rheumatic manifestations of human immunodeficiency virus infection. Am J Med 1988, 85:59-64.
2. Bessen JL, Greene JB, Louie E, Seitzman P, Weinberg H. Severe polymyositis: like syndrome associated with zidovudine therapy of AIDS and ARC. N Engl J Med 1990, 317:708.
3. Dalakas MC, Illa I, Pezeshkpour GH, Laukaitis JP, Cohen B, Griffin JL. Mithocondrial myopathy caused by long-term zidovudine therapy. N Engl J Med 1990, 322:1098-1105.
4. Dalakas MC, Pezeshkpour GH. Neuromuscular diseases associated with human immunodeficiency virus infection. Ann Neurol 1988, S23:38-48.
5. Dalakas MC, Pezeshkpour GH, Gravel M, Sever JL. Polymiositis associated with AIDS retrovirus. JAMA 1986, 256:2381-2383.
6. Dalakas MC, London T, Gravell M, Sever JL. Polymyositis in an immunodeficiency disease in monkeys induced by a type D retrovirus. Neurology 1986, 36:569-572.
7. Gabbai AA, Schmidt B, Castelo A, Oliveira ASB, Lima JGC. Muscle biopsy in AIDS and ARC: analysis of 50 patients. Muscle and Nerve 1990, 13:541-544.
8. Gonzales MF, Olney RK, Yuen TS, Greco CM, McQuin AM, Miller RG, DeArmond SJ. Subacute structural myopathy associated with human immunodeficiency virus infection. Arch Neurol 1988, 45:585-587.
9. Kaye BR. Rheumatologic manifestations of infection with human immunodeficiency virus. Ann Intern Med 1989, 111:158-167.
10. Simpson DM. Myopathy associated with human immunedeficiency virus (HIV) but not with zidovudine. Ann Intern Med 1988, 110:842.
11. Till M, MacDonell KB. Myopathy with human immunodeficiency virus type 1 (HIV-1) infection: HIV-1 or zidovudine ? Ann Intern Med 1990, 113:492-494.
12. Wiley CA, Nepenberg M, Cros D, Soto-Aguilar MC. HTLV-1 polymyositis in a patient also infected with the human immunodeficiency virus. N Engl J Med 1989, 320:992-995.
13. World Health Organization. Report of consultation on the neuropsychiatry aspects of HIV infection. Geneva, 14-17 march, 1988.

Aids e miopatia relato de um caso e revisão da literatura

AIDS and myopathy: case report and literature review

Datas de Publicação

Publicação nesta coleção
22 Fev 2011
Data do Fascículo
Set 1991

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Berman A, Espinoza LR, Diaz JD, Aguilar JL, Rolando T, Vazey FB, Germain BF, Loekey RF. Rheumatic manifestations of human immunodeficiency virus infection. Am J Med 1988, 85:59-64.

[2] 2. Bessen JL, Greene JB, Louie E, Seitzman P, Weinberg H. Severe polymyositis: like syndrome associated with zidovudine therapy of AIDS and ARC. N Engl J Med 1990, 317:708.

[3] 3. Dalakas MC, Illa I, Pezeshkpour GH, Laukaitis JP, Cohen B, Griffin JL. Mithocondrial myopathy caused by long-term zidovudine therapy. N Engl J Med 1990, 322:1098-1105.

[4] 4. Dalakas MC, Pezeshkpour GH. Neuromuscular diseases associated with human immunodeficiency virus infection. Ann Neurol 1988, S23:38-48.

[5] 5. Dalakas MC, Pezeshkpour GH, Gravel M, Sever JL. Polymiositis associated with AIDS retrovirus. JAMA 1986, 256:2381-2383.

[6] 6. Dalakas MC, London T, Gravell M, Sever JL. Polymyositis in an immunodeficiency disease in monkeys induced by a type D retrovirus. Neurology 1986, 36:569-572.

[7] 7. Gabbai AA, Schmidt B, Castelo A, Oliveira ASB, Lima JGC. Muscle biopsy in AIDS and ARC: analysis of 50 patients. Muscle and Nerve 1990, 13:541-544.

[8] 8. Gonzales MF, Olney RK, Yuen TS, Greco CM, McQuin AM, Miller RG, DeArmond SJ. Subacute structural myopathy associated with human immunodeficiency virus infection. Arch Neurol 1988, 45:585-587.

[9] 9. Kaye BR. Rheumatologic manifestations of infection with human immunodeficiency virus. Ann Intern Med 1989, 111:158-167.

[10] 10. Simpson DM. Myopathy associated with human immunedeficiency virus (HIV) but not with zidovudine. Ann Intern Med 1988, 110:842.

[11] 11. Till M, MacDonell KB. Myopathy with human immunodeficiency virus type 1 (HIV-1) infection: HIV-1 or zidovudine ? Ann Intern Med 1990, 113:492-494.

[12] 12. Wiley CA, Nepenberg M, Cros D, Soto-Aguilar MC. HTLV-1 polymyositis in a patient also infected with the human immunodeficiency virus. N Engl J Med 1989, 320:992-995.

[13] 13. World Health Organization. Report of consultation on the neuropsychiatry aspects of HIV infection. Geneva, 14-17 march, 1988.