J Rheum Dis.  2011 Sep;18(3):203-207. 10.4078/jrd.2011.18.3.203.

A Case of Dermatomyositis Presenting with Rhabdomyolysis

• Lee HS
• Jee YG
• Song SH
• Sung SY
• Lee JH
• Yang JW
• Han BG
• Jung SH
• Park JH
• Kang TY

• KMID: 2223151
• DOI: http://doi.org/10.4078/jrd.2011.18.3.203

Abstract

Rhabdomyolysis is caused by injury to skeletal muscle and it involves leakage of intracellular contents into the plasma. Rhabdomyolysis is an extremely rare manifestation of dermatomyositis. Dermatomyositis is a rare idiopathic inflammatory myopathy that is characterized by chronic inflammation of skeletal muscles and skin, resulting in muscle weakness. A 20 year old Korean male soldier presented with acute muscle pain, weakness and skin rashes over the face, neck and anterior chest. He received military training with carrying a radio set one week previouslyago. The patient was treated for rhabdomyolysis. However, the patient's symptoms did not improve. Muscle biopsy results suggested the diagnosis of rhabdomyolysis. Nevertheless, the features of skin and muscle inflammation raised the possibility of dermatomyositis. High dose steroid treatment was started, and then the symptoms and signs of muscle inflammation were improved. Rhabdomyolysis as the presenting sign of dermatomyositis has not been reported in Korea. Thus, we report on this case with a literature review.

Keyword

Dermatomyositis; Inflammatory myopathy; Rhabdomyolysis

MeSH Terms

Biopsy
Dermatomyositis
Exanthema
Humans
Inflammation
Korea
Lifting
Male
Military Personnel
Muscle Weakness
Muscle, Skeletal
Muscles
Myositis
Neck
Plasma
Rhabdomyolysis
Skin
Thorax

Figure

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  Figure 1. (A) Skin rashes over the neck and anterior chest (the V sign) were seen, and this was characteristic for dermatomyositis. (B) Gottron's papules appearing as scaly papules on the extensor surfaces over the metacarpophalangeal joint were observed.

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  Figure 2. MRI of the shoulder (A) and thigh (B) demonstrates diffuses high signal intensity in the shoulder muscles (triceps, coraco-brachialis, latissimus dorsi, teres major, infraspinatus, subscapularis muscle) and thigh muscles (vastus, adductor, biceps femoris, gracillis, sartorisu, pectineus muscle), which is consistent with inflammatory myopathy.

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  Figure 3. Muscle biopsy of the right infraspinatus muscle. There are focally necrotized muscle fibers without infiltration of inflammatory cells (arrow), which is suggestive of rhabdomyolysis (H&E stain, ×400).

Reference

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