iatroX Rounds #33
The clues
- 1
A 52-year-old woman presents with a three-month history of progressive difficulty rising from a low chair and climbing stairs.
- 2
She also describes difficulty lifting her arms to wash her hair or reach for items on high shelves.
- 3
She reports a persistent reddish-purple rash on her eyelids and cheeks that is aggravated by sunlight.
- 4
Examination reveals violet discolouration of the upper eyelids and scaly, erythematous papules over the knuckles of both hands.
- 5
Initial blood tests show a significantly elevated creatine kinase level of 4500 U/L and a positive anti-Mi-2 antibody screen.
- 6
Muscle biopsy demonstrates perimysial inflammation and characteristic perifascicular atrophy.
Dermatomyositis is an idiopathic inflammatory myopathy characterized by symmetrical, proximal muscle weakness and distinct cutaneous features. It often occurs as a paraneoplastic syndrome, necessitating a search for underlying malignancy in adult patients.
- Symmetrical proximal muscle weakness
- Heliotrope rash (periorbital violet discolouration)
- Gottron's papules over the knuckles
- Elevated creatine kinase
for education and entertainment. not medical advice.