Challenges in Treating Dermatomyositis-Related Rhabdomyolysis: A Case Report of Steroid-Induced Myopathy

BACKGROUND Rhabdomyolysis, although typically associated with immobilization, trauma, or the use of certain medications, can also manifest as a severe and potentially life-threatening complication of dermatomyositis. This condition results from the breakdown of skeletal muscle, presenting with symptoms such as myalgia, muscle weakness, and myoglobinuria. Although high-dose steroids are the treatment of choice in cases of dermatomyositis-related rhabdomyolysis, they can trigger the onset of steroid-induced myopathy. CASE REPORT A 50-year-old woman with bilateral muscle weakness, myalgia, erythematous-papular rash, urine abnormalities, and significantly elevated liver transaminases was mistakenly admitted to the Gastroenterology Department due to suspected acute liver damage. After initial management, the patient was diagnosed with dermatomyositis-related rhabdomyolysis. The introduction of high-dose systemic steroid therapy resulted in a deterioration of her clinical condition and triggered the appearance of additional symptoms (dysphagia, dysphonia, difficulty breathing and coughing effectively). Due to the suspicion of the acute steroid-induced myopathy, the steroid was promptly discontinued, which resulted in a noticeable reduction in the severity of the new symptoms. After 2 days, we restarted steroid treatment at a lower dose, along with intravenous immunoglobulin therapy, obtaining gradual clinical improvement. CONCLUSIONS Deterioration of general condition or new symptoms appearing after steroid administration should always raise suspicion of acute steroid-induced myopathy, which may overlap with dermatomyositis. Differentiating between the exacerbation of myositis symptoms and steroid-induced myopathy is problematic and not always possible. In case of suspected steroid-induced myopathy, steroid should be used at the lowest effective dose or replaced by a non-steroidal agent.