Dermatomyositis from cutaneous changes to chronicity, a case report

Abstract

Context: Dermatomyositis is an inflammatory myopathy, which results from loss of tolerance to a select group of autoantigens, with an incidence of approximately 0.8 to 1.2 per 100,000, of bimodal distribution, more frequent in women, with important relationship with paraneoplasia, usually responsive to treatment. Case report: female, 65 years old, black, rural worker, with history of increased skin pigmentation in early 2019. After two months, she was bedridden, with dysphagia. Physical examination revealed paresis, poikiloderma on the face, alopecia, remnants of uper back shawl sign, Heliotrope and Gotron sign. Complementary investigation showed: aldolase 20.4 / 31; CPK: 521/220/207. Anatomopathological examination of skin biopsy reveald superficial and discrete lymphocytic dermatitis with focal pigmentary incontinence; electroneuromyography presented myopathic pattern in the four limbs. Paraneoplastic investigation was negative. There was a response to corticosteroids and metotrexato. Conclusions: The case shows a rapid progression from cutaneous symptoms to chronic symptoms and highlights the importance of recognizing skin lesions in view of the possible differential diagnoses in the neurology specialty, prior to the onset of the classic clinical picture and the appearance of chronic symptoms.