Anti-melanoma differentiation-associated gene 5 and anti-Ro52 antibody-dual positive dermatomyositis accompanied by rapidly lung disease: Three case reports

Table 1 Comparison of cumulative survival rates of 200 patients with endometrial cancer based on clinical characteristics

Laboratory parameter	Case 1	Case 2	Case 3
Age	40	43	40
Gender	F	F	F
White cell counts (× 109/L) (3.5-9.5)	9.82	7.72	6.26
Haemoglobin (115-150)	139	97	100
Platelets (× 109/L) (126-350)	143	192	235
CRP (mg/L) (0-3)	3.46	6.07	1.84
ESR (mm/hour) (0-15)	7.6	47	58
AST (IU/L) (13-35)	430	206	414
ALT (IU/L) (7-40)	215	134	282
LDH (IU/L) (120-250)	482	380	470
CK (IU/L) (40-200)	1484	17	108
Albumin (g/L) (40-55)	27.5	32.9	27
Ferritin (ng/mL) (12-135)	1640.38	87.56	458.49
Procalcitonin (ng/mL) (0-0.5)
Basline level at admission	0.11	0.13	0.1
On the day of worsening	0.24	0.32	0.1
C3 (mg/dL) (0.75-1.35)	0.46	1.04	0.77
C4 (mg/dL) (0.09-0.36)	0.27	0.18	0.28
ANA screening	1/1000	1/1000	1/320
Fluorescent pattern of ANA	Cytoplasmic	Cytoplasmic	Cytoplasmic
Anti-MDA5	Positive	Positive	Positive
Anti-Ro52	Positive	Positive	Positive

CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate; AST: Aspartate aminotransferase; ALT: Alanine transaminase; LDH: Lactate dehydrogenase; CK: Creatine kinase; ANA: Antinuclear antibody; Anti-MDA5: Anti-melanoma differentiation-associated gene 5.

Table 2 Description of clinical features, serologies, treatment and outcome of the 27 anti-melanoma differentiation-associated gene 5 and anti-Ro52 dual positive patients

Ref.	Age	Sex	Cutaneous	Pulmonary	Serologies	Treatment	Outcome
Huang et al[10]	52	M	Heliotrope, gottron’s periungual erythema	RP-ILD	MDA5 + Ro52 +	GC, CYC, RTX, ECMO, and MMF + Tac	Recurrent
	54	F	Heliotrope, gottron’s cutaneous ulcers	RP-ILD	MDA5 + Ro52 +	GC, IVIG, CYC, RTX, ECMO/lung Tx and now MMF + Tac	Improved
	59	F	Palmar papules, periungual erythema	RP-ILD	MDA5 + Ro52 +	GC, CYC, ECMO/lung Tx and now MMF + Tac	Improved
	43	M	Gottron’s, palmar papules, diffuse violaceous rash cataneous ulcers	RP-ILD	MDA5 + Ro52 +	GC, CYC, rituximab	Dead
	69	M	Heliotrope, gottron’s	RP-ILD	MDA5 + Ro52 +	GC, CYC	Dead
	58	F	Gottron’s, mechanic’s hands, skin Bx	RP-ILD	MDA5 + Ro52 +	MMF, GC, CYC, CsA, RTX	Dead
	44	F	Gottron’s ulcerations	RP-ILD	MDA5 + Ro52 +	GC, MMF and RTX	Dead
	65	M	Heliotrope, gottron’s diffuse erytheatous rash, skin Bx, ulceration	RP-ILD	MDA5 + Ro52 +	GC, IVIG, CYC, imuran	Recurrent
	31	M	Gottron’s ulcerations, helitrope, skin Bx	RP-ILD	MDA5 + Ro52 +	GC, MTX, IVIG, MMF, AZA, CYC + Tac	Improved
	27	F	Heliotrope, gottron’s cutaneous ulcers periungual erythema	ILD	MDA5 + Ro52 +	GC, AZA, MMF, IVIG, RTX + Tac	Recurrent
	59	F	Helitrope, gottton’s cutaneous ulcers, periungualerythema, mechanic’s hand	ILD	MDA5 + Ro52 +	GC, HCQ, AZA, CsA, MMF, RTX	Improved
	51	F	Periorbitaledema, heliotrope, Gottron’s, palmar papules, periungual erythema	ILD	MDA5 + Ro52 +	GC, MTX, AZA, IVIG, MMF, PLEX, IV epoprostenol	Improved
	59	M	Facial rash, skin ulcers, palmar papules	ILD	MDA5 + Ro52 +	GC, IVIG, MMF	Ongoing
Gupta et al[9]	27	F	Upper eyelids, extensor surface of hands and digit	ILD	MDA5 + Ro52 +	GC, CsA, IVIG	Improved
Mehta et al[12]	37	F	Unkown	ILD	MDA5 + Ro52 +	CYC, IVIG	Dead
	42	F	Unkown	ILD	MDA5 + Ro52 +	GC, rituximab	Dead
Chen et al[24]	48	F	Facial rash	ILD	MDA5 + Ro52 +	GC, MMF hydroxychloroquine	Improved
Huang et al[11]	50	F	Unkown	RP-ILD	MDA5 + Ro52 +	GC, TAc, CYC, IVIG	Dead
	42	F	Unkown	RP-ILD	MDA5 + Ro52 +	GC, CYC	Improved
	51	F	Unkown	RP-ILD	MDA5 + Ro52 +	GC, CYC, IVIG	Dead
	30	F	Unkown	RP-ILD	MDA5 + Ro52 +	GC, CYC, IVIG	Improved
	46	M	Unkown	RP-ILD	MDA5 + Ro52 +	GC, CsA, CYC	Improved
	58	M	Unkown	RP-ILD	MDA5 + Ro52 +	GC, CYC, MTX	Improved
Xu et al[17]	28	F	Gottron’s ulceration	RP-ILD	MDA5 + Ro52 +	GC, IVIG	Improved
Current	40	M	Heliotrope, gottron’s	RP-ILD	MDA5 + Ro52 +	GC, CYC, IVIG	Dead
	43	M	Heliotrope, gottron’s periungual erythema	RP-ILD	MDA5 + Ro52 +	GC, CYC, IVIG	Dead
	40	M	Heliotrope, gottron’s cutaneous ulcers mechanic’s hand	RP-ILD	MDA5 + Ro52 +	GC, CYC, IVIG	Improved

ILD: Interstitial lung disease; RP-ILD: Rapidly progressive interstitial lung disease; MDA5: Melanoma differentiation-associated gene 5; GC: Glucocorticoid; CYC: Cyclophosphamide; RTX: Rituximab transplant; ECMO: Extracorporeal membrane oxygenation; MMF: Mycophenolate; IVIG: Intravenous immunoglobulins; MTX: Methotrexate transplant; AZA: Azathioprine; HCQ: Hydroxychloroquine; PLEX: Plasma exchange; TAc: Tacrolimus; CsA: Cyclosporin.