Lege Artis Medicinae

[Severe polymyositis associated with multiplex pulmonary abscesses]

SZABÓ Katalin1, VINCZE Anett1, NAGY-VINCZE Melinda1, DANKÓ Katalin1, GRIGER Zoltán1

JULY 20, 2019

Lege Artis Medicinae - 2019;29(06-07)

DOI: https://doi.org/10.33616/lam.29.032

[INTRODUCTION – Idiopathic inflammatory myopathies are heterogeneous autoimmune diseases characterized by immune mediated inflammation of the skeletal muscles. CASE REPORT – A case of a 62-year-old male patient with severe proximal muscle weakness, elevated creatine kinase and swallowing difficulity is presented. Electromyography showed myogenic pattern, thus probable polymyositis was diagnosed. Radiological examination has confirmed bilateral multiplex lung lesions, which were caused by the possibility of tumor, tuberculosis, vasculitis and abscess as well. The condition of the patient deteriorated, nasogastric feeding, high dose steroid treatment was initiated, which reduced the patient's creatinine kinase values, but muscle strength was not changed. Based on the results of various investigations, the condition of the patient was finally confirmed by the development of myositis, resulting dysphagia, chronic aspiration, and multiplex lung abscess. Antibiotic therapy, steroid treatment was continued and finally intravenous immunoglobulin treatment was administered. The condition of the patient gradually improved, the swallowing dysfunction disappeared, and the lung abscesses were resolved. As a result of physiotherapy and rehabilitation treatment, the patient could walk again. CONCLUSIONS – Nasogastric feeding is recommended to prevent aspiration in the case of myositis-associated dysphagia. In case of steroid refractory therapy, the use of intravenous immunoglobulin may be effective. ]


  1. Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Immunológiai Tanszék



Further articles in this publication

Lege Artis Medicinae

[Empirical examination of the persistence value among the students studying health-care at the beginning of student professionalization]

DINYÁNÉ Szabó Mariann, PUSZTAI Gabriella

[INTRODUCTION – Students in healthcare studies can help maintain the mental base and maintain their health if the lecturers know the degree of student persistence. When entering higher education, it is possible to measure the pre-university experience. Persistence determines the student's relationship to learning and can be a predictor of learning success. PARTICIPANTS AND METHODS – A questionnaire study (N = 200) of the 1st year student (N = 200) of the Health Care Organization (BSc) of the University of Debrecen and Semmelweis University. For the continuous Persistence Variable a descriptive statistical method was used, an independent two-sample t-test was used for comparison between groups, and Hedges-g was used to express the effect size. We used the GLM (General Linear Model) model for fitting the persistence model. By means of factor analysis, we constructed factors from the significant predictor variables of the GLM model, which helped us assessing students' chances of learning. To quantify the strength of evidence against null hypothesis P < 0.05 (5% significance) was chosen as a standard level for concluding that there is evidence against the hypothesis tested. Statistical analysis was performed with IBM SPSS Statistics 24.0 (SPSS, Chicago, IL). RESULTS – The persistence factor loadings can be divided into three types: high, medium and low. High persistence rearranges student preferences, low interest persistence, minimal interest in academic engagement. In the case of middle-ranking people, the importance of volunteering (life-experience) and friendship is paramount. CONCLUSIONS – The results indicate that at the beginning of the student life there is a willingness, diligence, acceptance of academic values, interest or lack of interest in future success studies. During the stu­dies, these features can be monitored and the necessary interventions can be made in time.]

Lege Artis Medicinae

[One Million Patients Live with Diabetes in our Country, but the Dismal Trends Seem to Turn Around]


Lege Artis Medicinae

[Epidemiology, comorbidity, etiology of depression and cardiovascular diseases]

PÉTER László, RIHMER Zoltán

[Psychiatric problems are a common comorbid condition in patients with cardiovascular disease. Depression is a well-known risk factor for the development of cardiovascular disease and mortality too. Psychiatric and cardiovascular diseases are prevalent public health problems in the western world. Depression is associated with endo­thelial dysfunction and increased platelet aggregation, which may explain the consequent cardiovascular complications. Specific affective temperaments may be associated with special cardiovascular diseases. Antidepressant therapy does not only reduce depression but also cardiac mortality.]

Lege Artis Medicinae

[The Magic Flute – Mozart’s Opera in the Crossfire of Interpretations ]


Lege Artis Medicinae

[The red eye]

IMRE László

[Eye redness may be a sign of a variety of eye diseases with different severity. Most often redness is relatively harmless, such as conjunctivitis, but it can be a serious illness with visual impairment and even lasting consequences in the background of redness. It is therefore important for non-ophthalmologists to be informed and to know the basic types of redness of the eye and to recognize typical and characteristic forms of appearance. Based on these, they can decide whether the patient can be treated or forwarded to an ophthalmic institution. In the present continuing education article we try to summarize the causes of the red eye, primarily according to the characteristics of the redness of the eye and the anatomical localization. During the investigation of a patient with red eye, the type of the redness can be determined most by diffuse illumination and by naked eye inspection without any other means. It is important to know the principal features and causes of redness of conjunctival or ciliary or scleral origin, possible other recognizable differences (e.g. conjunctival papillae or follicles or conjunctival chemosis). We have attempted to illustrate these with a number of photographs, starting with a schematic representation of the characteristic features of redness. We tried to emphasize cases suitable for treating by non-ophthalmologists and tried to draw attention to the importance of referral un­clear or complicated cases.]

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Lege Artis Medicinae



[Idiopathic inflammatory myopathies are systemic autoimmune diseases with an immune-mediated inflammation of the striated muscles which lead to progressive muscle weakness. Their cause is still unknown, but recently the understanding of the molecular immunopathology has improved, which may as well offer therapeutic targets in the future. The aim of this review is to present currently available data on the most important factors and processes that are involved in the pathogenesis of these diseases. Although glucocorticoids remain the cornerstone of the treatment for the major forms of idiopathic inflammatory myopathies, there are other efficacious immunosuppressive agents with fewer side effects. The authors discuss classic treatment regimens as well as more recent therapeutic approaches.]

Lege Artis Medicinae


TÁLLAI Béla, MORSHED Ali Salah, FLASKÓ Tibor, PONYI Andrea, DANKÓ Katalin, TÓTH Csaba

[INTRODUCTION - In some cases of polymyositis/ dermatomyositis (PM/DM) of autoimmune origin, different malignant tumours can initiate the difficult cascade mechanisms at cell level leading to the rapid weakness of the skeletal muscles. Till now, in the international literature only four cases of PM/DM associated with cancer of prostate has been reported. CASE REPORT - Authors present a case of a 57 yearold male patient, where weakness in patient's movements developed leading to total immobility in 3 months. Purple discoloration developed on his hand and face. Significantly elevated creatin kinase (CK) levels and blood sediment rate with mild anaemia were observed during laboratory examinations. Dysphagia and lack of appetite resulted in the loss 10 kgs in body weight. Both clinical evaluation, elevated serum CK level, skin symptomes, positive electromyography and muscle biopsy confirmed acute definitive dermatomyositis. Urological examination revealed a palpable hard area at the right lobe of the prostate. Prostate biopsy confirmed the presence of carcinoma in the right lobe of the prostate. There was no sign or symptome referring to either local propagation or distant manifestation. Therefore, radical prostatectomy was performed, the tumorous prostate and both seminal vesicles were removed. Histological examination proved malignant focus in the right lobe of the prostate. After the operation patient gradually became stronger, corticosteroid medication were decreased then stopped. Patient's original muscle power and movement recovered and his previous body weight was regained. During the regular control examinations all results of laboratory tests are in normal range. CONCLUSION - In the background of some autoimmune diseases malignant tumours can be revealed. It is rare when urological neoplasms initiative the process. In men with PM/DM commencing beyond 50 years of age it is necessary to think of the presence of prostate cancer, which can be cured by performing radical operation in appropriate time.]

Hungarian Immunology

[Ocular myositis]

KISS Emese, FACSKÓ Andrea, DÉVÉNYI Katalin, DANKÓ Katalin, ZEHER Margit

[INTRODUCTION - Dermato-/polymyositis is an autoimmune disorder, which belongs to the idiopathic inflammatory myopaties. It involves skeletal muscles in form of weakness and inflammatory infiltrates. Characteristic skin lesions are present in dermatomyositis. Other organs may also be affected mainly in the presence of myositis specific autoantibodies. The inflammation usually involves the proximal muscles of extremities. CASE REPORT - In the present work we report the case of a 52-year-old woman. In the previous history the removal of rectal adenocarcinoma was remarkable in 1994. After that she received chemotherapy. She complied for severe headache and pain in the right eye in 2000 October, therefore a skull CT was performed, indicating thickening of rectus medalis muscle within orbital cavity. There was an enhancement of contrast material in the muscle. Glaucoma was excluded. Neurologist suspected the presence of myositis and indicated 0.5 mg/kg corticosteroid therapy. Soon after the left eye became painful, but due to the corticosteroid treatment both eyes became painless. A control orbital CT was completely negative in 2000 November. Immunology consultancy revealed a mild proximal muscle atrophy in both lower extremities, but CPK and LDH enzyme levels were normal, EMG was characteristic for mild chronic nerve lesion. The biopsy, taken from the involved proximal muscle of lower extremity, did not show inflammatory infiltration. Complete screening for cancer was negative. Thyroid gland disease could be excluded. Immune laboratory data were negative, autoantibodies, including anti-Jo1, could not be detected. Based on the results a rare disease, ocular myositis was diagnosed. Considering the clinical improvement, the withdrawal of corticosteroid therapy was offered. Stringent immunology and oncology follow-up is required. CONCLUSION - In relation to our case report, we discuss clinical symptoms of orbital myositis, diagnostic procedures to identify the disease and also differential diagnostic considerations.]

Hungarian Immunology

[Anti-synthatase syndrome]


[The idiopathic inflammatory myopathies (IIM) are autoimmune diseases, characterized by symmetric proximal muscle weakness. Over the last several decades, many abnormalities of the cellular and humaral immune systems of IIM patients have been described. Some of these are autoantibodies unique to the IIM (the myositis specific autoantibodies MSA). The MSAs are antigen-driven, arise months prior to the onset of myositis, correlate in titre with disease-activity. Studies in the recent years proved that clinically and immuno-geneticaly different disease entities can be defined using myositis specific auto-antibodies. Their use make the serological classification. Myositis specific autoantibodies make it possible to define more homologies subgroups within polymyositis/dermatomyositis that may support the adequate treatment. The most common MSA is the antihistidyl- transfer RNA synthetase (anti-Jo-1), which can be found in 5-30% of patients with myositis. Patients with anti-synthatase antibodies tend to have characteristic clinical presentation of fever, small joint arthritis, intestinal lung disease, Raynaud's phenomenon, mechanic's hands and severe myositis. Sera of 65 PM/DM were tested for anti-Jo- 1 antibody. 15 patients (23%) had anti-Jo-1 antibody (10 PM, 5 DM). The patients with anti-Jo- 1 antibody has a significantly higher incidence of interstitial lung disease, arthritis, fever and Raynaud's phenomenon. These patients needed not only corticosteoid therapy, but other immunosupressive treatment. All 15 patients presented with the onset of weakness between February and July. The determination of myositis-specific autoantibodies has produced more homogenous grouping within the polymyositis/dermatomyositis patients.]

Lege Artis Medicinae


MÉSZÁROS Krisztina, HACKI Tamás, VARGA Zsuzsa

[The authors focus on the rehabilitation of patients with dysphagia caused by surgical and/or irradiative treatment of head and neck tumors as well as neurogenic diseases. The complex rehabilitation includes treatment of the oropharyngeal swallowing dysfunction as well as the therapy of communicative disabilities. The home care of patients with dysphagia, which can not only be life threatening, but also causes social isolation, is an important task for the general practitioner.]