Elderly Lupus Patient Presenting with Myositis � An Uncommon Presentation of a Common Disease

A 52-year-old married female presented with a history of generalized weakness for last 4 months aggravating over last two weeks. On clinical examination, we found Hyperpigmentation on her face and proximal muscle weakness in all four limbs, Alopecia; in routine investigations we found Anaemia, Thrombocytopenia, Raised Creatine Kinase. In imaging we found consolidation in left lower lobe, Nerve Conduction Velocity test showed brachial plexopathy and Sural Sensory Neuropathy, Electromyography showed fibrillation potentials and increased insertional activity in Gastrocnemius medial head, Tibialis anterior, Biceps brachii. We also performed muscle biopsy which showed findings suggestive of Dermatomyositis. Summarizing all the findings, we thought the cause to be an underlying Connective Tissue Disorder, hence we send samples for ANA, ENA profile which showed ANA 4+ homogenous, Ro52+++, RNP++, SS-A++; which led us to the final diagnosis of Systemic Lupus Erythematosus.

SARS-Cov-2 infection and severe proximal myopathy secondary to dermatomyositis and overlap systemic sclerosis: A Case Report from Zambia

Background: Myositis has been reported to be associated or triggered by viruses. Genetic and environmental factors are documented risk for myopathies. Viruses have also been shown to modify the clinical course of auto-immune diseases. We therefore report a case of SARS-Cov-2 infection in a 26-year-old female black Zambian patient with proximal myopathy. Case Presentation: We present the case of a 26-yearold chemical factory worker with severe acute respiratory distress syndrome corona virus 2 (SARS-cov-2) infection and proximal myopathy. She presented to a local private hospital with fever, weakness and flu-like symptoms after being exposed to a colleague diagnosed with SARS-cov-2 infection at the time Zambia declared the July 2021 third wave of SARS-cov-2pandemic. She also reported difficulties in climbing stairs, had Raynaud's phenomenon, proximal myopathy, classic dermatomyositis features, symptoms of systemic sclerosis, raised creatine phosphokinase (CPK), and a positive nasopharyngeal PCR test for SARS-Cov-2 infection. Conclusions: We presented, for the first time in Zambia, the case of a patient with SARS-Cov-2 infection and severe proximal myopathy secondary to newly diagnosed dermatomyositis and overlap systemic sclerosis. The myopathy appeared to have been worsened by SARS-Cov-2 viral infection.

Juvenile Dermatomyositis with Calcinosis Cutis.

A 6-year-old girl presented with irregular fever for last two months and difficulty in standing from sitting position for last 1½ months. She had pathognomonic heliotrope rashes on both eyelids, Gottron’s papules in proximal interphalangeal and metacarpophalangeal joints of both hands and papules on elbow, knee and ankle joints. She had elevated serum muscle enzyme levels and electromyogram was in favor of juvenile dermatomyositis (JDM). She is now under steroid treatment and showing signs of improvement.