Refractory polymyositis undergoing remission following antitubercular therapy

Area of Science:

• Immunology
• Infectious Diseases
• Rheumatology

Background:

• Immunosuppressive therapy is crucial for managing autoimmune diseases but increases opportunistic infection risk.
• Polymyositis, an autoimmune condition, often requires intensive immunosuppression, potentially compromising host defense.
• Miliary tuberculosis is a severe disseminated form of tuberculosis, particularly concerning in immunocompromised individuals.

Observation:

• A woman with polymyositis refractory to high-dose steroids and methotrexate developed miliary tuberculosis.
• The patient's polymyositis showed remission following antitubercular therapy, even with reduced immunosuppression intensity.

Findings:

• This is the first reported case where myositis achieved remission by treating an intercurrent infection.
• Antitubercular therapy was effective in resolving the autoimmune myositis symptoms.

Implications:

• Treating infections may offer a therapeutic strategy for certain autoimmune disease flares.
• The complex interplay between autoimmune disease activity and infection warrants further investigation.
• This case underscores the importance of considering and managing infections in immunosuppressed patients with autoimmune diseases.