Acute lyme infection presenting with amyopathic dermatomyositis and rapidly fatal interstitial pulmonary fibrosis: a case report

Abstract

Introduction: Dermatomyositis has been described in the setting of lyme infection in only nine previous case reports. Although lyme disease is known to induce typical clinical findings that are observed in various collagen vascular diseases, to our knowledge, we believe that our case is the first presentation of acute lyme disease associated with amyopathic dermatomyositis, which was then followed by severe and fatal interstitial pulmonary fibrosis only two months later.

Case presentation: We present a case of a 64-year-old African-American man with multiple medical problems who was diagnosed with acute lyme infection after presenting with the pathognomonic rash and confirmatory serology. In spite of appropriate antimicrobial therapy for lyme infection, he developed unexpected amyopathic dermatomyositis and then interstitial lung disease.

Conclusions: This case illustrates a potential for lyme disease to produce clinical syndromes that may be indistinguishable from primary connective tissue diseases. An atypical and sequential presentation (dermatomyositis and interstitial lung disease) of a common disease (lyme infection) is discussed. This case illustrates that in patients who are diagnosed with lyme infection who subsequently develop atypical muscular, respiratory or other systemic complaints, the possibility of severe rheumatological and pulmonary complications should be considered.

Figure 1

Mechanic's hands in a patient with dermatomyositis. Image reprinted with permission from emedicine.com, 2009. Available at: http://emedicine.medscape.com/article/1064945-overview

Figure 2

Vacuolar changes of columnar epithelium and lymphocytic inflammatory infiltrates at the dermal-epidermal interface in dermatomyositis. Image reprinted with permission from emedicine.com, 2009. Available at: http://emedicine.medscape.com/article/1064945-overview.

Figure 3

Interstitial pulmonary fibrosis in our patient's computed tomography scan of the chest.