A therapeutic perspective for refractory polymyositis to corticosteroids and immunosuppressant drugs: A case report

BACKGROUND: Polymyositis (PM) is a chronic, disabling, and progressive inflammatory disease with muscle and systemic involvement. Although it is uncommon, some patients may present drug resistance to initial treatment with corticosteroid and immunosuppressant drugs. CASE REPORT: In this study, a typical case of poor prognosis of a 40-year-old female with PM who presented resistance to the initial treatment with corticosteroids and immunosuppressants was presented. The first medication tested was prednisone for 30 days and then 5 pulses of methylprednisolone were performed for 5 months, and since there was no effect, a combination of azathioprine and methotrexate was performed for 8 months, which was also unsatisfactory. Then, the scheme was changed to cyclophosphamide, human immunoglobulin (HIG), and cyclosporine, which were also unable to change the clinical course of the disease, which led the prescriber to radically change the drug therapy to the immunobiological rituximab (RTX), the only medication capable of ensuring an excellent therapy response and recovery of muscle strength. CONCLUSION: This report demonstrates the importance of the necessary persistence for the prescriber to test certain classes and drug combinations in search of the best possible therapeutic response for the specific case, which only occurred after the prescription and proscription of the drugs of first choice and the change to the immunobiological drug, RTX.