Angio‐oedema induced by ACE inhibitors

D S, an increased prevalence of polymyositis in human T-cell lymphotropic virus type I (HTLV-I)infected patients has been described [1]. However, the outcome and the management of these kinds of polymyositis cases are not clearly established. A 36-year-old woman was admitted on September 1993 because of severe myalgia. Two weeks before admission, asthenia and progressive muscle weakness developed. Her temperature was 37±6°C, her general medical examination was normal except for severe proximal muscle weakness, and her neurological examination was otherwise normal. The standard laboratory values were normal except for serum creatine phosphokinase and serum aspartate transaminases, slight inflammatory syndrome, polyclonal hypergammaglobulinaemia, positive circulating immune complex and increased C3 and C4 components of complement. Cryoglobulinaemia was negative. The electromyogram disclosed only myopathic changes. Deltoid biopsy revealed endomysium mildly infiltrated by lymphocytes and atrophic and necrotic muscles fibres, some of which had undergone phagocytosis. There was no vasculitis of the blood vessels or inclusion bodies. Serum HTLV-Iantibody tests were positive by ELISA and western blotting. Drug-induced myopathies, systemic diseases, neoplasm and infectious diseases other than HTLV-I (HIV, Influenzae, Parainfluenzae, Coxsakievirus, Lyme, Trichinosis, and Toxoplasmosis) were excluded. The diagnosis of primary idiopathic polymyositis was made. All symptoms resolved within three weeks without any corticosteroid treatment, and the patient was found to remain free of any such symptoms after 18 months of follow-up. The pathogenesis of polymyositis in HTLV-Iinfected patients is not clearly known and seems to be related to an immunological process and}or direct infection of the muscle fibres by virus [2, 3]. The clinical history of this patient suggests that in polymyositis associated with HTLV-I infection, the prognosis should not be very different from the other idiopathic polymyositis. Spontaneous clinical remission is especially possible. Hence, in such cases the use of corticosteroids, prescribed usually as a firstline drug therapy, may be delayed and reserved for relapses. This observation opens the discussion about the benefits of early corticosteroid therapy in some cases of polymyositis. Prospective studies are needed to determine the prognostic markers of these categories of polymyositis.