Inflammatory myopathies in Lome: a review of two cases with delayed diagnosis

Abstract

Inflammatory myopathies (IMDs) are a group of heterogeneous autoimmune diseases affecting the muscles. We report 2 cases of IMD managed in Lomé, Togo. The first patient is a 37-year-old black female, who had progressive onset of peripheral neuropathy for about ten years. Clinical assessment revealed pseudo-hypertrophy of the calves and shoulders, muscular atrophy of several muscle groups, bilateral steppage gait, and tetraparesis. CPKs were 6 times above the normal, and the electroneuromyogram (ENMG) showed an IMD pattern. Antinuclear autoantibodies came back positive at 320. The second patient is a 32-year-old black female with a history of myopathy who was admitted for constrictive retrosternal chest pain. Clinical assessment was remarkable for fever and pigmented macules in the upper limbs. Echocardiography was in favour of pericarditis, ENMG showed an IMD pattern, a thoracic CT showed bilateral posterobasal septal thickening, and 24-hour proteinuria was positive. Antinuclear autoantibodies were positive at 1280. Both patients were diagnosed with systemic lupus erythematosus-myositis overlap syndrome and were treated with corticosteroids and methotrexate. In conclusion, IMDs exist in Togo. Their diagnosis is challenging due to clinical polymorphism and a limited technical platform.