Classic dermatomyositis in a 36-year-old Filipino female: A case report with emphasis on the early recognition of cutaneous findings of dermatomyositis

ABSTRACT

INTRODUCTION@#Dermatomyositis is a rare idiopathic inflammatory myopathy with characteristic skin manifestations and proximal muscular weakness. In 30 percent of classic dermatomyositis, skin findings precede muscle weakness. Since the initial skin lesions are not always highly characteristic of dermatomyositis, there may be a delay in diagnosis and treatment.@*CASE REPORT@#This is a case of a 36-year-old Filipino female who initially presented with erythematous patches and plaques on the face, arms, and thighs. One week later, she developed multiple, well-defined, erythematous to violaceous, edematous, tender patches and plaques on the face, V of the neck, upper back, proximal extremities and buttocks. Seven weeks later, she developed proximal muscle weakness described as difficulty in raising her arms and difficulty in standing up from a sitting position. Histopathology was consistent with dermatomyositis. SGPT, C3, ANA, and anti-ds-DNA were normal. SGOT and creatine kinase were 5 and 15 times the normal value, respectively. She was treated with prednisone from the first week of illness and hydroxychloroquine from the fifth week of illness. Her condition greatly improved with no progression of the disease for the succeeding 3 years.@*CONCLUSION@#Even in the absence of muscle weakness, there should be a high index of suspicion for dermatomyositis in patients with confluent, erythematous patches and plaques on the face, trunk and proximal extremities. Adequate work-up and clinical monitoring will pave the way for early diagnosis and consequently early treatment and a better patient outcome.