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Pulmonary Fibrosis and Dermatomyositis

D. Robert Webb, MD
JAMA. 1975;234(10):1018-1019. doi:10.1001/jama.1975.03260230018010.
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To the Editor.—  The CLINICAL GRAND ROUNDS entitled "A Case of Dermatomyositis" (233:66, 1975) presents the essentials of dermatomyositis in a very well-balanced fashion. I would like to comment on Dr Druger's discussion of pulmonary complications. I suggest that although pulmonary fibrosis is usually considered rare, it is common among patients with polymyositis and, unfortunately, not sought for or recognized.Since caring for a man with dermatomyositis presenting as pulmonary fibrosis in 1970 (222:1146, 1972), I have seen at least six patients with this pulmonary complication. Dyspnea, nonproductive, irritative cough, and fine basilar crepitant rales were prominent in all of these patients. Diffusing capacities were less than 50% of predicted in all except one. Four of the five patients with followup responded to either corticosteroids, immunosuppressive therapy, or both. Pulmonary symptoms preceded recognition of muscle weakness in three of these subsequent patients; therefore, seeking occult muscle disease in patients with


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