Chest
Volume 102, Issue 6, December 1992, Pages 1875-1876
Journal home page for Chest

Pulmonary and Critical Care Pearls
Dyspnea and Muscle Weakness in a 65-Year-Old Woman

https://doi.org/10.1378/chest.102.6.1875Get rights and content

Section snippets

Physical Examination

Vital signs: normal except for respiratory rate of 24 breaths/min. Chest: anterior and posterior bibasilar mid-late inspiratory crackles. Cardiac: grade 2/6 systolic murmur at left sternal border. Extremities: no cyanosis or clubbing; peripheral edema of ankles and lower legs. Neurologic: marked and diffuse muscle weakness, particularly involving the proximal muscles. Skin: normal.

Laboratory Findings

Hematocrit, 40.5 percent; WBC, 7,800 µl with normal differential; creatine phosphokinase, 3,959 IU/L; lactate dehydrogenase, 2,287 IU/L. Rheumatoid factor: negative. Thyroid function: normal. Chest radiograph: bilateral lower lobe infiltrates with small left pleural effusion (Fig 1). Pulmonary function tests: forced vital capacity (FVC), −1.67 L (55 percent predicted); total lung capacity, 3.35 L (66 percent predicted); FEV1, 1.34 L (60 percent predicted); FEV1 FVC ratio, 80; diffusing capacity

Diagnosis: Polymyositis with bronchiolitis obliterans with organizing pneumonitis

Since its original description in 1956, the association between parenchymal lung disease and polymyositis has become well established. Open lung biopsy specimens from patients with polymyositis/dermatomyositis have demonstrated three major histologic patterns: bronchiolitis obliterans with organizing pneumonitis (BOOP); usual interstitial pneumonia; and diffuse alveolar damage. The histologic categorization of the lung biopsy specimen in a patient with polymyositis/dermatomyositis may better

Clinical Pearls

  • 1.

    Pulmonary manifestations of polymyositis include respiratory muscle weakness, various interstitial lung diseases, aspiration pneumonia secondary to dysphagia, pleural effusions, and pulmonary alveolar proteinosis. The presence of BOOP in polymyositis has a more favorable prognosis than usual interstitial pneumonitis or diffuse alveolar damage.

  • 2.

    Measurement of inspiratory and expiratory mouth pressures is important in patients with neuromuscular disease because the severity of respiratory muscle

References (0)

Cited by (12)

  • Predicting oxygen uptake for men and women with moderate to severe chronic obstructive pulmonary disease

    2003, Archives of Physical Medicine and Rehabilitation
    Citation Excerpt :

    These differences are the result of the computed interaction effects of sex on the model. The importance of exercise testing in patients with COPD is well documented.24-26 Assessment of exercise capacity assists in the differential diagnosis; assessment of functional capacity delineates the impact of dyspnea on daily function and derives training guidelines for those individuals wishing to enter self-directed or center-sponsored rehabilitation programs.

  • Cryptogenic organising pneumonia

    2006, European Respiratory Journal
  • Organizing Pneumonia: Cryptogenic and Disease Associated

    2003, Seminars in Respiratory and Critical Care Medicine
View all citing articles on Scopus
View full text