SHM Converge Scientific Abstract ePoster Gallery-The Autoimmune Jackpot: Diagnosing Lupus-Myositis Overlap Syndrome

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This case describes a 48-year-old woman with a history of fibromyalgia who developed a severe systemic autoimmune overlap syndrome consistent with SLE–myositis. Over 3 months, she experienced progressive dyspnea, profound proximal and distal muscle weakness, fever, recurrent pneumonia-like episodes, oral ulcers, weight loss, and inflammatory skin findings including a unilateral heliotrope rash and pruritic papules/plaques on the trunk and limbs. Her disease progressed to respiratory failure with bilateral pleural effusions and a pericardial effusion.<br /><br />Diagnostic evaluation showed hemolytic anemia, elevated ESR, low complement levels, positive ANA (1:640 homogeneous), low anti-DNA, and possible anti-Ro positivity. Importantly, creatine kinase was normal or only mildly elevated, highlighting that normal CK does not exclude inflammatory myopathy. MRI demonstrated muscular edema and atrophy in pelvic and scapular regions, electromyography showed a myopathic pattern, and muscle biopsy supported inflammatory myopathy with recent denervation.<br /><br />She required critical care with mechanical ventilation, empiric antibiotics for pneumonia, high-dose methylprednisolone pulses, intravenous immunoglobulin, and hydroxychloroquine. She later transitioned to oral prednisone taper, methotrexate, and scheduled IVIG. With treatment, she improved markedly and regained independent ambulation.<br /><br />The case emphasizes that SLE–myositis overlap is rare but potentially life-threatening, especially when pulmonary involvement is present. Early recognition, multidisciplinary care, and aggressive immunomodulatory therapy are essential to improve outcomes and preserve function.

Asset Subtitle

Lucas Gortz

Meta Tag

Author List Anna Victoria Valiente Engelhorn, Eduardo Dos Santos Paiva, Evelyn Carolina Suquebski Dib, Laura Brandão De Proença, Leticia Chaffin Barbosa Peruffo, Lucas Gortz, Pedro Henrique De Abreu Da Silva

Category Clinical Vignettes

Concept Lupus-Myositis Overlap Syndrome

Concept Inflammatory Myopathy

Concept Immunomodulatory Therapy

Concept Respiratory Support

Concept Systemic Lupus Erythematosus

Distinguished Non-Finalist

Presenter Organization Complexo Hospital De Clínicas - Universidade Federal Do Paraná (CHC-UFPR)

Presenting Author Lucas Gortz

Track Adult

Keywords

systemic lupus erythematosus

myositis overlap

inflammatory myopathy

heliotrope rash

respiratory failure

pleural effusion

pericardial effusion

normal creatine kinase

intravenous immunoglobulin

methylprednisolone

Lupus-Myositis Overlap Syndrome

Inflammatory Myopathy

Immunomodulatory Therapy

Respiratory Support

Systemic Lupus Erythematosus