A Cutaneous Lesion Associated With Primary Polymyositis

Abstract

Polymyositis is a nonsuppurating inflammatory disease of the striated muscle characterized clinically by the presence of proximal muscular weakness that is sometimes associated with pain. 1 This disease falls within a broader category known as idiopathic inflammatory myopathy, which includes the forms of myositis that are secondary to connective tissue disease and neoplasms and myositis with inclusion bodies. 2 Polymyositis is differentiated from dermatomyositis by the absence of the characteristic cutaneous lesions. 1 Stahl et al 3 reported the presence of hyperkeratosis of the fleshy pad and the lateral aspect of the fingers to be a marker for idiopathic inflammatory myositis. We describe a woman with primary polymyositis associated with hyperkeratosis of the fingers of both hands. REPORT OF A CASEA 55-year-old housewife presented in August 1991 with arthromyalgia, predominantly in the-upper limbs, affecting the shoulders, wrists, and metacarpophalangeal and proximal interphalangeal joints of both hands. She also complained of having a sensation of loss of strength. The patient also reported the parallel development of fissures and thickening of the distal portion of the fingers of both hands.After treatment with nonsteroidal antiinflammatory drugs, the polyarthralgia improved, but the fingertip lesions remained unchanged. The patient later noted generalized muscular weakness with stiffness, pain, and heaviness of the lower extremities that limited her ability to perform household tasks, climb stairs, and sit in a chair. During this second phase, edema of the feet and legs appeared. There were no other cutaneous