Case of Dermatomyositis in a 66-Year-Old Woman

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Dermatomyositis
Source: the New England Journal of Medicine

Dermatomyositis – inflammatory disease with symptoms of muscle weakness and skin rash

Dermatomyositis is an inflammatory disease that manifests with symptoms including muscle weakness and a skin rash. The condition affects both adults and children, alike. Adults are usually affected by the disease in their late 40s and early 60s. Whereas in children the disease appears between the 5 and 15 years of age. Subsequently, studies have suggested that it affects females more than males.

This article describes the case of a 66-year-old woman who presented to the outpatient clinic with a pruritic rash that appeared 7 months ago. Her medical history revealed that she had previously been diagnosed with eczema, for which she was on topical glucocorticoids. However, despite treatment, her condition did not improve. Other symptoms the patient reported of included fatigue, shortness of breath and muscle weakness, consistent with dermatomyositis.

Physical examination findings showed hyperpigmented and erythematous papules

Physical examination was significant for hyperpigmented, erythematous papules over the metacarpophalangeal and interphalangeal joints of both hands. The findings were consistent with the diagnosis of Gottron’s papules, flat-topped, erythematous papules found particularly on the metacarpophalangeal joints, proximal interphalangeal joints and distal interphalangeal joints. Examination also revealed dilated capillaries of the proximal nail folds, dyschromic patches, plaques, and poikiloderma on the posterior shoulders (shawl sign) and poikilodermatous, dyschromic changes of the lateral thighs (Holster sign).

Doctors further tested the patient’s proximal arms strength, the result of which was 3 out of 5. This shows that you can fully contract a muscle with full range of motion against the force of gravity. Based on these findings, the patient was given the diagnosis of dermatomyositis. The condition is also known to be associated with certain cancer, for this reason, she was evaluated for underlying cancer. The results of which came back negative.

Dermatomyositis rashes can have variable presentations depending on the dermatologic skin type of patients. Some patients also present with hyperpigmentation and dyschromia, marked erythema and violaceous changes.

Doctors treated the patient with a 3-month course of mycophenolate mofetil, intravenous immune globulin, and prednisone. During this time, the patient’s glucocorticoids were tapered. After treatment, the patient’s dyspnoea, weakness and cutaneous findings showed improvement. Although, there is currently no cure for dermatomyositis, treatment can help improve symptoms, regain muscle strength and function.

References

Dermatomyositis https://www.nejm.org/doi/full/10.1056/NEJMicm2033425

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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