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Case Report DOI: 10.7241/ourd.20132.40 SYMPTOMATIC MACROGLOSSIA AND TONGUE MYOSITIS IN DERMATOMYOSITIS Ajili Faida 1 , Bousseta Najeh 1 , Msakni Issam 2 , Metoui Leila 1 , Gharsallah Imen 1 , Laabidi Janet 1 , Ben Abdelhafidh Nadia 1 , Louzir Bassem 1 , Ammar Bouziani 2 , Othmani Salah 1 Source of Support: Nil Competing Interests: None 1 Department of Internal Medecine, Military Hospital of Tunis, 1008, Tunisia 2 Department of Anatomopathology, Military Hospital of Tunis, 1008, Tunisia Corresponding author: Dr Ajili Faida faida1977@yahoo.fr Our Dermatol Online. 2013; 4(2): 176-178 Date of submission: 23.02.2013 / acceptance: 20.03.2013 Abstract The involvement of the tongue in dermatomyositis is rarely described in the literature. We report the case of a patient having a macroglossia whose etiologic was a dermatomyositis. The diagnosis was established by biopsy of the tongue which showed an interstitial lymphocytic infiltration associated with destruction of muscle fibers and perifascicular atrophy. The treatment was based on corticosteroids. The functional prognosis was dominated by the gene to speech and the swallowing disorders. Key words: macroglossia; tongue myositis; dermatomyositis Cite this article: Ajili Faida, Bousseta Najeh, Msakni Issam, Metoui Leila, Gharsallah Imen, Laabidi Janet, Ben Abdelhafidh Nadia, Louzir Bassem, Ammar Bouziani, Othmani Salah: Symptomatic macroglossia and tongue myositis in dermatomyositis. Our Dermatol Online. 2013; 4(2): 176-178. Introduction The macroglossia is observed in certain congenital muscle disease such us Becker’s and Duchenne’s dystrophies or Pompe’s disease. It rarely occurs in polymyositis. We report the case of a symptomatic macroglossia with myositis of the tongue associated with dermatomyositis. Case Report A 65 years old man was admitted in our service for macroglossia and macrochely (Fig. 1, 2) associated with a swallowing disorders with false routes and frequent tonguebiting during mastication lasting for a year. He had also an incomprehensible speech and complained of muscle weakness involving the shoulder and pelvic girdles and the limbs. The patient was in a good general condition. Blood pressure was 120/70 mmHg and cardiovascular examination was normal. On physical examination, a slight decrease in muscle strength in all 4 limbs and girdles was noted. He had a significant macroglossia with a falling of the lower lip and a nasal speeech. No skin abnormalities were observed and the neurological examination was strictly normal. The cell blood count was normal and there was no biological inflammatory syndrome. The creatinine phosphokinase (CPK) level was elevated at 606 IU/l and lactate dehydrogenase (LDH) at 416 IU/l. The hepatic and renal function was normal. Electromyography confirmed a diffuse typical myositic process. Muscle biopsy revealed necrotic muscle fibers, regenerating fibers, an endo- and perimysial inflammatory infiltrate and a perifascicular atrophy. The different etiologies of macroglossia have been eliminated by appropriate investigations. Thyroid balance was normal and biopsy of the tongue with congo red staining showed no amyloid deposits. Enzymatic assays were not made in the absence of clinical signs towards genetic myopathies. The biopsy of the tongue showed a phenotype T interstitial inflammatory infiltrate and perifascicular atrophy without neoplastic cells (Fig. 3). The diagnosis of dermatomyositis sine dermatisis revealed by tongue myositis was certain according to the Bohan and Peter criteria. The search for possible neoplasia was negative (thoraco-abdominal scan and tumor markers). The diagnosis of tongue carcinoma has been ruled out by the tongue biopsy. The patient was treated by prednisone at a dose of 1 mg/ kg/day associated with methotrexate (20 mg/week) for five years with no improvement of the symptoms. Imunoglobulin infusions were administered so at a dose of 2 g/kg by cure. The patient received six cures spaced by one month. Evolution was marked by the disappearance of the muscular deficit, standardization of CPK and LDH levels, the partial reduction of macroglossia, improvement of speech and the disappearance of false routes. The current decline is of 12 months. 176 © Our Dermatol Online 2.2013 www.odermatol.com
Page 1 and 2: Volume 4, Number 2, April 2013 ISSN
Page 3: Editorial Board: Abdel-Naser Mohame
Page 6 and 7: CONTENTS E d i t o r i a l O r i g
Page 8 and 9: Original Article DOI: 10.7241/ourd.
Page 10 and 11: Figure 1. Survival time of HIV/TB-
Page 14 and 15: Figure 3. A. melanocytic naevus on
Page 18 and 19: 82% of the children belonged to the
Page 20 and 21: Comment to the article DOI: 10.7241
Page 22 and 23: The skin around body openings such
Page 24 and 25: Figure 1. Finger nail dystrophy in
Page 28 and 29: Similar type of rash was also prese
Page 30 and 31: 13. Mastaglia FL, Ojeda VJ: Inflamm
Page 32 and 33: Figure 1. Atrophic areas on left up
Page 36 and 37: Figure 1. Macroglossia Figure 2. Ma
Page 38 and 39: Case Report DOI: 10.7241/ourd.20132
Page 40 and 41: Figure 4a, b. Skin biopsy shows hyp
Page 46 and 47: Discussion Poikiloderma of Civatte
Page 52 and 53: Case Report A 56 year old Caucasian
Page 54 and 55: Using a battery of neurotoxic agent
Page 56 and 57: Figure 1. Multiple lesions on the u
Page 60 and 61: Figure 1. a PAS positive accentuati
Page 62 and 63: The patient was put on melanocyl 0.
Page 66 and 67: The type of treatment prescribed by
Page 68 and 69: On the basis of these clinical find
Page 70 and 71: Surgery has been reported to be the
Page 72 and 73: Figure 1. Histological section show
Page 76 and 77: Discussion The breast location of t
Page 78 and 79: Figure 2. The epithelial nests show
Page 82 and 83: Discussion SCACP is one of the cuta
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Figure 1. Tumor of the nasal colume
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Figure 2. Vesicles and crusts aroun
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Outbreaks have occurred recently in
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Clasificación En base al epitelio
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- Microcefalia, hipoplasia mediofac
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Caso Nº 3: · Niña, edad desconoc
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Clinical Images DOI: 10.7241/ourd.2
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Figure 7. Fixed cutaneous sporotric
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Letter to the Editor DOI: 10.7241/o
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Historical Article DOI: 10.7241/our
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Figure 6. Henri Mondor (1885-1962).
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Figure 5. Alfred Guido Miescher (18
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Names of ''Lines'', in dermatology
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Figure 1. Erik Adolf von Willebrand
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THOMAS INMAN English physician, 182
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There are three type of tinea capit
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