PMC5140874_01
MRI findings of the lower limb muscles. (A) Coronal section. (B) Horizontal section.
1349-7235-55-3197-g001.jpg
PMC5140874_01_1349-7235-55-3197-g001.jpg
g001
Although an electromyogram showed a mild positive sharp wave in the gluteus maximus, enhanced MRI demonstrated discretely granular hyperintensities on T1 in the gluteus maximus and femoral muscles (Fig. 1), which were not consistent with inflammatory myositis.
A muscle biopsy of the femoral muscle. (A) Fibrinoid necrosis of a medium-sized vessel (Hematoxylin and Eosin staining, 400x). (B) Disruption of the elastic lamina of the vessel wall (Elastica van Gieson stain, 400x).
1349-7235-55-3197-g002.jpg
PMC5140874_01_1349-7235-55-3197-g002.jpg
g002
A biopsied specimen of the femoral muscle revealed fibrinoid necrosis of small-sized arteries (100 mum) with inflammatory cell infiltrate and disruption of the elastic lamina of the vessel wall without findings of myonecrosis (Fig. 2).
The clinical course of the patient. The x-axis indicates the date and the y-axis indicates the CRP levels (mg/dL) and (1 3) -beta-D-glucan levels (pg/dL). PSL: prednisolone, mPSL: methylprednisolone, BMZ: betamethasone, IVCY: intravenous cyclophosphamide, MEPM: meropenem, ST: sulfamethoxazole/trimethoprim, MRI: magnetic resonance imaging
1349-7235-55-3197-g003.jpg
PMC5140874_01_1349-7235-55-3197-g003.jpg
g003
We added monthly intravenous cyclophosphamide (IVCY) of 1,000 mg, which resulted in normalization of the CRP level (Fig. 3).