Résumé :
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Patients who have been treated with bone marrow transplantation and survived beyond 100 days often have chronic graft-versus-host disease (GVHD). Myositis or myopathy is usually rare in chronic GHVD. We report a 31-year-old woman who had myositis in the course of chronic graft-versus-host disease after allogeneic haematopoietic stem cell transplantation for acute lymphocytic leukemia. This woman was diagnosed as acute lymphocytic leukemia in 1990 at our hospital. She underwent chemotherapy and radiotherapy, benefited finally in 1995 from bone marrow transplantation and had in complete remission. Cyclosporin A and steroids had been given to prevent acute GHVD for several months. In 2005, the patient was admitted in hospital in a context of general fatigue, weight loss, abdominal pain with diarrhoea and myalgias. Also, she presented skin disease scleroderma-like.Muscular atrophy was noted in the 4 limbs but predominant in proximal muscles particulary in legs (quadriceps), the weakness was generalised but predominant in axial muscles almost cervical. These symptoms had deteriorated progressively. The patient had elevated levels of creatine kinase, liver enzymes were middly increased. The most specific laboratory examinations revealed elevation of lactate deshydrogenase, aldolase, rate of antinuclear, anti-liver kidney microsomal and anti-mitochondrial antibodies. Electromyography found myogenic pattern in quadriceps, deltoid and in axial muscles. The muscle biopsy with histological and immunohistochemical study did not show typical histology of polymyositis.The diagnosis of late onset myositis, occuring 10 years after transplantation was etablished. The patient responded quickly to prednisone with clinical remission, levels of creatine kinase were reduced partially. In conclusion, we presented myositis which emerged in the course of chronic GVHD, probably caused by a cellular immune reaction of donor T cells.
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