A48‐year‐old woman was admitted to the hospital with shortness of breath and generalized weakness. She noted 3 months of a progressive weakness, and the recent onset of progressive eyelid swelling. She also noted pleuritic chest pain, dyspnea on exertion, muscle pain in the shoulders and thighs, and overall general malaise. Her vital signs were normal, as were her cardiac, pulmonary, and abdominal examinations. She had symmetric weakness that was more prominent in the proximal versus the distal muscles. She had diminished reflexes at The patella and ankle. TTiere was an erythematous rash of both eyelids and nodules on the proximal interphalangeal joints (PIPS). No spasticity or cerebellar signs were noted. Her ANA and serum CK were elevated; the remainder of laboratory values were normal, including herTSH. An anti‐Jo antibody was ordered.
Generalized weakness is a common complaint that is often encountered by the internist. A systematic approach to determining the cause is important in identifying modifiable diseases. One method is to work systematically Ihrough a complete motor exam to narrow the differential diagnosis Irom brain to spinal cord to nerve to neuromuscular junction to muscle. In this patient, the utility of a complete skin exam was instrumental in making the proper diagnosis There are 5 main categories of myopathy: (1) toxic, (2) endocrine, (3) hereditary, (4) infectious, and (5) inflammatory In the subgroup of inflammatory myopathies, dermatomyositis has characteristic skin findings to help confirm the diagnosis.
Dermatomyositis is a disease characterized by progressive proximal symmetrical weakness, elevated levels of muscle enzymes, abnormal EMG, and abnormal muscle biopsy. It predominately affects adults in the fourth to sixth decades or children between the ages of 5 and 15. Women are more commonly affected Than men. It can develop over weeks to months and has periods of remission, A complete review of systems may reveal muscle pain/tenderness, fatigue, fever, weight loss, GI ulcers, alopecia, and lung complaints. An ANA is useful to exclude the disease if it is negative, but the more specific anti‐Jo antibody is more useful in confirming the disorder. As with all categohes of dermatomyositis/polymyositis, age‐appropriate cancer screening should be employed to exclude an underlying malignancy.
S. Heimburger, none.