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Case Reports
. 2017 Jul 26;11(1):203.
doi: 10.1186/s13256-017-1368-2.

Hypercapnic respiratory failure during pregnancy due to polymyositis-related respiratory muscle weakness: a case report

Husain Shabbir Ali  1 , Ibrahim Fawzy Hassan  2 , Saibu George  2 , Abdalrazig Elsadig Fadlelmula  2
Affiliations
Case Reports

Hypercapnic respiratory failure during pregnancy due to polymyositis-related respiratory muscle weakness: a case report

Husain Shabbir Ali et al. J Med Case Rep. .

Abstract

Background: Polymyositis is a rare medical disorder complicating pregnancy. Ventilatory muscle weakness leading to respiratory failure is an uncommon manifestation of this autoimmune disease. We report a case of life-threatening hypercapnic respiratory failure due to polymyositis-related respiratory muscle weakness in a pregnant woman.

Case presentation: A 31-year-old, African woman in her second trimester of pregnancy presented to the emergency department with fever, shortness of breath and muscle weakness. Initial investigations excluded pulmonary infection, thromboembolism, and cardiac dysfunction as the underlying cause of her symptoms. She developed deterioration in her level of consciousness due to carbon dioxide narcosis requiring invasive mechanical ventilation. Further workup revealed markedly elevated serum creatine kinase, abnormal electromyography and edema of her thigh muscles on magnetic resonance imaging. Diagnosis of polymyositis was confirmed by muscle biopsy. After receiving pulse steroid, intravenous immunoglobulins, and maintenance immunosuppressive therapy, our patient's respiratory muscle function improved and she was weaned off mechanical ventilation. Despite good maternal recovery from critical illness, the fetus developed intrauterine growth retardation and distress necessitating emergency cesarian section.

Conclusions: New-onset polymyositis during pregnancy presenting with respiratory failure is rare. Early diagnosis and prompt initiation of therapy is necessary to improve fetal and maternal outcomes.

Keywords: Inflammatory myopathy; Polymyositis; Pregnancy; Respiratory failure.

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Conflict of interest statement

Ethics approval and consent to participate

The Medical Research Center at Hamad Medical Corporation, Qatar granted permission for publication of this case report.

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Chest imaging of the patient. a Chest X-ray on admission: prominent bronchovascular markings bilaterally. Hazy opacity noted in left lower lung field. b Chest computed tomography scan: bilateral basilar dependent atelectasis, more on the left side
Fig. 2
Fig. 2
Needle electromyography. a Increased insertional activity of right first dorsal interosseous (FDI) muscle. b Spontaneous fibrillation potential and positive sharp waves of right trapezius muscle. c Myopathic motor unit potential and early recruitment of right iliopsoas muscle. μV microvolt, ms millisecond, mV millivolt
Fig. 3
Fig. 3
Magnetic resonance images of both thighs. a Coronal short T1 inversion recovery image. b Axial short T1 inversion recovery image. Diffuse hyperintensity in thigh muscles suggestive of edema – (i) vastus lateralis, (ii) vastus medialis, and (iii) adductor magnus
See this image and copyright information in PMC

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