SHM Converge Scientific Abstract ePoster Gallery-Mda5 Dermatomyositis With Rapidly Progressive Interstitial Lung Disease

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This case describes a 65-year-old woman with hypertension, hyperlipidemia, coronary artery disease, and tobacco use who was hospitalized for worsening shortness of breath, cough, and hypoxia. Initial chest CT showed multifocal pneumonia, and she was treated with IV antibiotics and discharged on oral antibiotics and home oxygen after temporary improvement. Two weeks later, she returned with recurrent and worsening respiratory symptoms. Repeat CT showed worsening bilateral pulmonary opacities, raising concern for COVID-19 pneumonia, multifocal pneumonia, or another inflammatory lung process. Despite two negative COVID tests and treatment with pulse-dose IV steroids, her respiratory failure progressed rapidly, requiring BiPAP and then intubation. A faint rash over the knuckles suggested Gottron’s papules, prompting a myositis panel and treatment with IV tocilizumab, but her condition continued to deteriorate and she died. The myositis-specific antibody panel later returned positive for high-titer anti-MDA5 antibody.<br /><br />The discussion emphasizes that anti-MDA5 dermatomyositis is a form of dermatomyositis strongly associated with rapidly progressive interstitial lung disease (RP-ILD). Skin findings may include Gottron-like lesions, oral ulcers, and painful palmar papules or macules. Because lung involvement can dominate the presentation, it is often mistaken for infections such as bacterial pneumonia or COVID-19. RP-ILD in MDA5 dermatomyositis has a poor response to therapy and high early mortality, making prompt recognition essential. Early diagnosis and aggressive immunosuppressive treatment may improve outcomes.<br /><br />This case highlights the need to consider MDA5 dermatomyositis in patients with unexplained, rapidly worsening hypoxia, bilateral pulmonary infiltrates, and suggestive skin findings.

Asset Subtitle

Prodip Paul

Meta Tag

Author List Julio Ramos, Koushik Paul, Mishouri Paul, Prodip Paul

Category Clinical Vignettes

Concept Anti-MDA5 Dermatomyositis

Concept Rapidly Progressive Interstitial Lung Disease

Concept Anti-MDA5 Antibody

Concept Interstitial Lung Disease

Concept Dermatomyositis

Distinguished Non-Finalist

Presenter Organization Geisinger Community Medical Center, Scranton, PA

Presenting Author Prodip Paul

Track Adult

Keywords

anti-MDA5 dermatomyositis

rapidly progressive interstitial lung disease

bilateral pulmonary infiltrates

hypoxia

Gottron's papules

myositis-specific antibody

COVID-19 mimic

pulmonary opacities

immunosuppressive therapy

respiratory failure

Anti-MDA5 Dermatomyositis

Rapidly Progressive Interstitial Lung Disease

Anti-MDA5 Antibody

Interstitial Lung Disease

Dermatomyositis