重叠综合征并发横纹肌溶解症一例

A case of overlap syndrome complicated with rhabdomyolysis

74岁女性患者,手足及口周部位皮肤变硬2个月余,伴乏力、酱油色尿1个月。血清肌酸激酶4 242 U/L,肌红蛋白1 124 ng/ml。诊断为重叠综合征并发横纹肌溶解症。经甲泼尼龙80 mg每日1次、甲氨蝶呤15 mg每周1次治疗,效果不理想,转入肾病内科行血液净化治疗。血清肌红蛋白恢复正常后,继续口服甲泼尼龙40 mg每日1次,定期复诊并缓慢减量。目前甲泼尼龙减量至16 mg/d,己持续治疗1年,血清肌酸激酶及肌红蛋白均在正常范围。

A 74-year-old female presented with sclerosis of the skin of the hands,feet and around the mouth for more than 2 months,accompanied by fatigue and soy sauce color urine for 1 month.Serum creatine kinase was 4 242 U/L and myoglobin was 1 124 ng/ml.The diagnosis was overlap syndrome complicated with rhabdomyo lysis.After had been treated by methylprednisolone 80 mg/d and methotrexate 15 mg once per week,the therapeutic effect of which was not satisfactory,then,the patient was transferred to nephrology department for further blood purification therapy.After the serum myoglobin returned to normal range,the patient was instructed to continue to take methylprednisolone 40 mg once a day orally,followed by regular follow-up visits and slow dose reduction of methylprednisolone.At present,the dosage of methylprednisolone has been reduced to 16 mg/d which has lasted for 1 year,and the serum levels of creatine kinase and myoglobin were in normal range.