Lesson of the month
Dermatomyositis
how far to go!
Rheumatology
Department, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB
Correspondence to: Dr Till.
Accepted for publication 3 March 1998
| The first 150 words of the full text of this article appear below. |
 |
Case history |
|---|
A 73 year old lady was referred with a four week history of proximal muscle weakness, myalgia and an erythematous, oedematous rash affecting her face, upper chest, and back. Systemic enquiry and general examination was otherwise unremarkable. Initial investigations revealed a normal full blood count, erythrocyte sedimentation rate, C reactive protein, urea and electrolytes, liver function test, thyroid function tests, and urine analysis. The creatine kinase (CK) was increased to 3806 (normal range 24-170 U/l). Although Mi-2 antibody testing was not carried out she did have an IgG ANA level of 100. The rest of the autoimmune screen was negative. A needle muscle biopsy showed type 2-fibre atrophy with perivascular inflammatory changes but no direct evidence of myositis.
She was given high dose oral prednisolone (60 mg daily) and received
two pulses of intravenous methylprednisolone (1 g) and cyclophosphamide
(1 g). Although the CK level responded rapidly to this treatment her
clinical response was more gradual.
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