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Rheumatology 2006 45(2):165; doi:10.1093/rheumatology/kei039
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

CLINICAL VIGNETTE

Subcutaneous lesions in dermatomyositis

P. V. Voulgari, A. K. Zikou1 and A. A. Drosos

Rheumatology Clinic, Department of Internal Medicine and 1 Department of Radiology, Medical School, University of Ioannina, Ioannina, Greece

Correspondence to: A. A. Drosos, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece. E-mail: adrosos{at}cc.uoi.gr

A 38-yr-old woman with a longstanding dermatomyositis since 1992, in clinical remission for the last 5 yr, presented to our out-patient rheumatology clinic because of back pain and low-grade fever. The current treatment consisted of methotrexate (15 mg/week) and prednisolone 5 mg every other day. Physical examination revealed a temperature of 38°C, with normal vital signs and normal muscle strength. Skin examination revealed extensive subcutaneous lesions with tenderness and swelling involving the lateral areas of the back. A plain radiograph of the pelvis revealed the presence of subcutaneous calcifications, which were confirmed by a computed tomography scan. Chest radiograph and purified protein derivative skin test were negative. Routine laboratory tests, liver and muscle enzymes, and kidney function tests were within normal limits. The urine analysis was normal. Repeated blood and urine cultures were negative, while the C-reactive protein was 12 mg/l (normal value <6 mg/l). The dose of prednisolone was increased to 30 mg/day and after 10 days of treatment the subcutaneous lesions gradually improved and became softer without swelling and tenderness. One month later the patient was asymptomatic, the subcutaneous lesions were palpable and foci of calcinosis were present without signs of inflammation. The dose of prednisolone was tapered, and colchicine was added [1].

References

  1. Fuchs D, Fruchter L, Fishel B, Holtzman M, Yaron M. Colchicine suppression of local inflammation due to calcinosis in dermatomyositis and progressive systemic sclerosis. Clin Rheumatol 1986;5:527–30.[Medline]
Accepted 28 June 2005


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This Article
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