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Inclusion body myositis associated with celiac sprue and idiopathic thrombocytopenic purpura. (Case Report).

Article Excerpt
Abstract: We report an unusual case of a 51-year-old woman with inclusion body myositis associated with celiac sprue and idiopathic thrombocytopenic purpura. We propose that the presence of all three disorders together suggests that they may share an interrelated immune mechanism.

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Inclusion body myositis (IBM) is an inflammatory myoplathy characterized by progressive muscle weakness. Unlike the other inflammatory myopathies, IBM often involves the distal musculature and tends to be steroid nonresponsive. (1) Celiac sprue (CS) is a mucosal disorder of the small intestine. It may be asymptomatic or manifested by either intestinal malabsorptive symptoms or extraintestinal symptoms. (2) Idiopathic thrombocytopenic purpura (ITP) is characterized by a low platelet count, normally functioning bone marrow, and the absence of other disorders that may account for thrombocytopenia. Patients with ITP may be asymptomatic or may present with easy bruising, menorrhagia, or expistaxis. (3) The cause of CS appears to be autoimmune, whereas the cause of IBM remains undefined. (1,4) ITP is known to have an autoimmune cause. (5) Seven adult cases of CS occurring in association with ITP (6-11) two cases of IBM with ITP, (12,13) and one case of IBM occurring with CS (14) have been reported previously. We re port a case of IBM, CS, and ITP occurring in a middle-aged woman.

Discussion

We found several previous reports of concurrent IBM with CS, (14) IBM with ITP, (12,13) and CS with ITP. (6-11) However, we know of no other reported case of all three disorders occurring...