Excerpt
To the Editor:
We describe 2 patients with inflammatory myopathies who developed severe nontuberculous mycobacterium (NTM) infections while undergoing treatment with rituximab.
Case 1.
In 1998, a 55-year-old man presented with proximal weakness, heliotrope rash, nailbed vasculitis, and a diffuse erythematous maculopapular rash covering the back, buttocks, and legs. A skin biopsy was consistent with dermatomyositis. A comprehensive malignancy evaluation was negative. He initially improved with prednisone 1 mg/kg before later adding methotrexate (MTX) as a steroid-sparing agent. In 2003, relapses of weakness, weight loss, and refractory skin disease required the addition of hydroxychloroquine, fluctuating doses of prednisone, and MTX…
Footnotes
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Pathology slides courtesy of Dan Milner, MD (Boston, Massachusetts, USA).