Rich skin manifestations in dermatomyositis

A 49-year-old female patient presented with complaints of pain and weakness in the shoulders, arms and legs. About 2 weeks after the complaint of pain and weakness, purplish-red discolorations started on her face, around her eyes, and later on her neck and upper chest. She presented to us with purplish discoloration around her eyes (Fig. 1A) and diffuse red-purple discoloration on the neck and upper chest. In addition, raised lesions of pink-purple skin were observed on the extensor surfaces of the PIP joints on the hands, elbows and knees (Fig. 1B, 1C). Laboratory examination revealed CK: 549 AST: 61 ALT: 58 CR: 0.49 ESR: 54 mm/hour, ANA and ANA subgroups were negative.
In MR imaging, signal increase in T2 images and local contrast enhancement in post-contrast series were observed in bilateral thigh muscles (Fig. 2A and 2B). In view of current clinical and laboratory findings, the patient was diagnosed with dermatomyositis and was started on methyl prednisolone 120 mg/day (IV), hydroxychloroquine 2x200 mg, methotrexate 15 mg/week (PO), folic acid 5 mg/week, and calcium/vitamin D supplementation. On the 5th day of her treatment, she regressed to CK: 161 and LDH: 277. The patient, whose complaints of muscle weakness decreased and skin lesions started to regress, was discharged with a steroid dose reduction schedule, with the recommendation of outpatient control.