PMC5224770_01
Chest X-ray (A) and computed tomography (B) on presentation in November 2008. Chest X-ray showed bilateral ground-glass opacities (GGOs) and reticular shadows predominantly in the lower lung fields. Chest computed tomography showed bilateral GGOs, consolidation, and reticular shadows predominantly in the lower lobes. The volume of the lower lobes was reduced. Chest computed tomography performed in September 2009 (C) showed improvement of the GGOs; however, they increased in July 2010 (D, arrowheads). Computed tomography showed GGOs in the left lower lobe in October 2011 (E); however, they had increased in the left lower lobe in January 2013 (F, arrow).
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We diagnosed her as having ASS-ILD and increased her PSL dose to 50 mg/day, which improved the lung opacities (Fig. 1C). The PSL was gradually tapered, but new lung opacities developed in July 2010 when the PSL dose was at 9 mg/day (Fig. 1D). The lung opacities improved again (Fig. 1E), but new lesions developed in January 2013 when the PSL was at 5 mg/day (Fig. 1F).
Electromyographic findings. An electromyographic study revealed waning of neuromuscular potentials on repetitive low-frequency stimulation.
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Her muscle weakness partially and transiently improved immediately after intravenous administration of edrophonium chloride, and an electromyographic study revealed both waning of neuromuscular potentials on repetitive low-frequency stimulation and myogenic changes (Fig. 2).