Amyopathic dermatomyositis

doi:10.1046/j.1365-4362.2000.00047-5.x

Amyopathic dermatomyositis

2001-12-25

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DOI：10.1046/j.1365-4362.2000.00047-5.x

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A 54-year-old female patient with edema and erythema on both eyelids, hands, and neck was admitted to our clinic in December 1997. The lesions on the eyelids and neck appeared in September 1996, while the lesions on the hands appeared about 1 year later. The patient was using Simvastatyn 10 mg/day (Zocor) for the hyper-lipidemia and she had also diet-regulated diabetes mellitus. Systemic examination findings were normal. Chest X-ray was normal. Laboratory findings were as follows: erythrocyte sedimentation rate 7 mm/h, ASO 200 IU/mL, C-reactive protein (negative), RF (negative), CBC, urine analysis, liver, kidney functions, blood sugar and electrolytes were normal. Blood lipids were slightly increased. Antinuclear antibodies, anti-dsDNA, and VDRL were negative. Muscle enzyme values were normal (CPK, lactic dehydrogenase, SOOT). On dermatologic examination, edema and violaceous erythema around the eyelids and V of neck were present. There were erythema, squam, and violet-colored plane papules 0.5-1 cm in diameter on the metacarpals and extensor surfaces of metacarpophalangeal joints. (Figs 1 and 2) Gottron's papule diagnosis was made on the histopathologic examination of the biopsy of one of the papules. There was no muscle weakness on the neurologic examination. Electromyographic (EMG) and quantitative EMG were normal. No pathology was observed in the gastroenterology consultation conducted to explore the existence of an internal malignancy. A gynecologist was also consulted as the patient had postmenopausal bleeding; no pathology was observed in the vaginal smear, pelvic USG, and endometrial biopsy. The diagnosis of amyopathic dermatomyositis was made after a detailed clinical and laboratory investigation, and histopathologic examination. Chloroquine sulfate was started 250 mg/day for the cutaneous lesions in January 1998. The patient continued to take Simvastatyn 10 mg/day and to utilize the diabetes mellitus diet. In March 1998, new erythematous and scaly lesions appeared on the knees bilaterally. In May 1998, the erythema and edema on the eyelids have completely disappeared, and the hand and knee lesions have decreased. In June and September 1998, the EMG, quantitative EMG, and muscle enzyme values were normal. Our patient is still using chloroquine sulfate 250 mg/day and a few papules still exist on the dorsum of both hands.

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Amyopathic dermatomyositis

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