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Dr. A. M. Anvar , Punarnava Ayurveda Hospital   May 20, 2016, 5:36 p.m.
Case Study of Fulminent Dermatomyositis

Case Study of Fulminent Dermatomyositis

Mohammed Abdulla Khateeb Abdulla Al Shammakhi,19 year old gentle man was apparently normal before 3 years. He had an acute onset of lower back ache following a fall on his back.

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He was evaluated and was put on analgesics to reduce pain in a Left Heart Catheterization (LHC- a flexible tube is put into the left heart usually to diagnose heart problems).

 

The very next day his pain aggravated and developed symmetrical proximal weakness of extremities along with abnormal growth of skin. He was diagnosed as Fulminent Dermatomyositis, a connective-tissue disease related to polymyositis (PM) that is caused by the inflammation of muscles and skin. Dermatomyositis (DM) frequently affects the skin and muscles, which is a systemic disorder which can also affect the joints, the esophagus or the food pipe, the lungs, and the heart. The incidence of Dermatomyositis is estimated as 5.5 cases per million people.


Diagnosis Report


He had respiratory and oropharyngeal (the middle part of the throat) muscle involvement after presented with generalized rhabdomylosis causing renal and liver injury. He required continuous observation and prolonged admission to ICU. During his admission his condition was complicated by Healthcare Associated Infection and Gastro Intestinal bleed. Gradually his condition improved wuith treatments in due course.


He was admitted in our hospital on 04/12/2015 with the complaints of weakness of upper and lower limbs, unable to stand or walk without support, abnormal growth of skin over mid face, both elbows, shoulders, over pinnas and periauricular region of body, both thumbs, and scaling of scalp. He also complained about severe pain in lower back, both elbows, knees, difficulty in getting up from sitting position. He was on medicated with various steroids and immunosuppressive drug  tablets like  Azathioprine 50 mg twice daily and on calcium supplements.


Examination in Medical terms:


CVS – S1S2 heard, BP: 110/70mm of Hg.  Pulse Rate: 76/minute, Saturation – 97%

O/E Conscious, oriented, Chest – Clear, NVBS Gottron's sign - +ve,Erethamatous lesions over shoulders, elbow, extensor surface of MCPJ’s, IPJ’s , Heliotrope - +, Hand grip – weak, Upper and lower limbs limbs – 4/5 (B/L), Dorsiflexion – 3/5, TA tightness - +, scaling of scalp - +. During the course of treatment his blood picture including peripheral blood smear, arthritic panel, LFT, KFT, TFT, CRP and other parameters were monitored periodically. Initially he had insufficient Vitamin D3 levels  and marginally raised Creatinine phosphokinase and on repeated evaluation after 3 weeks it was within normal limits.


Ayurvedic Healing of Dermatomyositis


In Ayurvedic perspective Dermatomyositis is a disease condition which icludes the involvement of all the three Doshas viz Vata, Pitta and Kapha along with Rasa, Rakta and Mamsavaha srotodushti and could be considered as an Avarana Vata disorder (type of disease condition with complicated multitissue involvement).


He was initially treated with various external treatments like Kashayadhara, Lepana, Ksheeradhara etc which helped in reducing the inflammation along with amapachana medicines internally along with diet modifications. As a result pain gradually reduced, skin lesions started healing and tiredness also reduced. On the second phase he underwent a special preparative treatment called Samana snehapana (administration of medicated ghee in a specific manner with diet and lifestyle modifications) followed by the Panchakarma -Virechana (purification process). In the final phase of treatment appropriate rejuvenative medications were given.


With our treatment, severity of pain gradually reduced, skin rashes over eyelids and extensor surfaces started healing.


At the time of discharge patient was able to walk without support, scaling of scalp relieved, rashes over eyelids healed completely, pain in shoulders, elbows, knees and lower back, small joints of upper limbs, TA tightness reduced and strength of upper and lower limbs improved. He was discharged on 15/01/2016 with follow up advises and review after 4 months.


With the comprehensive approach of Ayurveda and its internal medications and  external applications, diet and life style modification along with permitted therapeutic exercises, within a time duration after 3 years, he started walking without support and was able to do the activities of daily living.

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