Various Manifestations of Rheumatic Disorders: Case 4 Idiopathic Dermatomyositis

A 76-year-old woman complained of progressive proximalmuscle weakness; achy pain in the buttocks, thighs, andcalves; and lilac discoloration of her eyelids, cheek, nose,knuckles, and fingernails.Examination confirmed heliotrope skin changes anddisclosed moderate weakness in the limb and girdle musculature.The patient's levels of muscle enzymes, includingcreatine kinase, aldolase, aspartate aminotransferase,alanine aminotransferase, and lactate dehydrogenase,were elevated, as was her erythrocyte sedimentation rate.An electromyogram revealed increased exertional activity,fibrillation potentials, and a typical myopathic pattern.Muscle biopsy was performed, and the findings were consistentwith inflammatory myositis. Evaluation for an underlyingmalignancy yielded negative results.The diagnosis of idiopathic dermatomyositis wasbased on 4 criteria: clinical picture, electromyographicfindings, elevated serum creatine kinase level, and biopsyreport. The patient was treated with prednisone, 60 mg/d,and was given physical therapy. Three months later, herstrength had improved by 80%.

(Case and photograph courtesy of Dr Gavin I. Awerbuch.)