DefinePK

Research Objective

To report a case of polymyositis associated with celiac disease and highlight the importance of immunological workup in patients with generalized symptoms.

Methodology

Case report detailing a 29-year-old male patient presenting with generalized weakness and body aches. Diagnostic approach included physical examination, laboratory workup (serum creatine kinase, liver function tests, urinalysis, electrolytes), immunological workup (autoantibodies, tumor markers), nerve conduction studies (NCS) and electromyography (EMG), muscle biopsy, and duodenal biopsy. Treatment involved prednisone and a gluten-free diet.

Methodology Flowchart

                        graph TD
    A["Patient Presentation: Weakness, Body Aches"] --> B["Diagnostic Workup"];
    B --> C["Physical Examination"];
    B --> D["Laboratory Tests: CK, LFTs, etc."];
    B --> E["Immunological Workup: Autoantibodies, Tumor Markers"];
    B --> F["NCS/EMG"];
    B --> G["Muscle Biopsy"];
    B --> H["Duodenal Biopsy"];
    C --> I["Clinical Findings"];
    D --> J["Biochemical Abnormalities"];
    E --> K["Immunological Profile"];
    F --> L["EMG Findings"];
    G --> M["Histopathological Findings"];
    H --> N["Celiac Disease Confirmation"];
    I & J & K & L & M & N --> O["Diagnosis: Polymyositis & Celiac Disease"];
    O --> P["Treatment: Prednisone, Gluten-Free Diet"];
    P --> Q["Outcome: Improvement"];                    

Discussion

The report discusses the association between inflammatory myopathies and other autoimmune diseases like celiac disease, suggesting a common autoimmune pathogenesis. It emphasizes the importance of early detection and management of polymyositis, noting potential systemic manifestations and poor prognostic factors.

Key Findings

The patient was diagnosed with polymyositis based on clinical presentation, elevated creatine kinase, myopathic abnormalities on EMG, and characteristic findings on muscle biopsy. Concurrently, a duodenal biopsy revealed moderate villous atrophy consistent with celiac disease. Autoimmune workup showed elevated levels of Anti Mi-2 alpha, Anti NXP2, Anti Ku, and Anti EJ antibodies. Treatment with prednisone led to improvement in muscle strength and normalization of creatine kinase levels.

Conclusion

This case highlights the co-occurrence of polymyositis and celiac disease, underscoring the necessity of comprehensive immunological investigations in patients presenting with generalized weakness and myalgia to ensure accurate diagnosis and timely treatment.

Fact Check

1. Patient Age: The patient is reported to be 29 years of age. (Confirmed in text)
2. Creatine Kinase Level: The patient's serum creatine kinase level was elevated at 3246 U/l. (Confirmed in text)
3. Publication Year: The article was published in 2023. (Confirmed in citation)

Mind Map