Korean J Med.  2009 Nov;77(5):654-658.

Successful treatment of bronchiolitis obliterans organizing pneumonia associated with polymyositis with a steroid inhaler and low-dose cyclophosphamide

• Yun CY
• Song R
• Moon KW
• Lee YJ
• Song YW

Abstract

Polymyositis is an inflammatory connective tissue disease involving, predominantly, skeletal muscle. Occasionally, it is complicated by serious interstitial pneumonia. The presence of interstitial pneumonia affects the prognosis and contributes substantially to the morbidity and mortality. Although the treatment recommendations for interstitial pneumonia in polymyositis are still not optimal, high-dose steroid or immunosuppressive agents such as methotrexate, azathioprine, cyclosporine A, or cyclophosphamide alone or in combination are effective in myositis-associated interstitial pneumonia in many cases. Nevertheless, the relative frequency of complications, such as opportunistic infection, steroid-induced myopathy, and steroid psychosis, limits the use of high-dose steroid or immunosuppressive regimens. Here, we describe our experience of combination treatment with a steroid inhaler and low-dose cyclophosphamide in a patient with bronchiolitis obliterans organizing pneumonia associated with polymyositis who developed steroid-induced myopathy during initial high-dose steroid and cyclosporine A treatment.

Keyword

Polymyositis; Bronchiolitis obliterans organizing pneumonia; Steroid-induced myopathy; Steroid inhaler

MeSH Terms

Azathioprine
Bronchiolitis
Bronchiolitis Obliterans
Connective Tissue Diseases
Cryptogenic Organizing Pneumonia
Cyclophosphamide
Cyclosporine
Humans
Immunosuppressive Agents
Lung Diseases, Interstitial
Methotrexate
Muscle, Skeletal
Muscular Diseases
Nebulizers and Vaporizers
Opportunistic Infections
Polymyositis
Prognosis
Psychotic Disorders
Azathioprine
Cyclophosphamide
Cyclosporine
Immunosuppressive Agents
Methotrexate