1
|
Fujisaki M, Kasamatsu H, Nishimura K, Yoshida Y, Muneishi Y, Yamaguchi T, Nishino I, Konishi R, Ichimura Y, Okiyama N, Oyama N, Hasegawa M. A case of anti-SAE1/2 antibody-positive dermatomyositis with extensive panniculitis: A possible cutaneous manifestation of treatment resistance. J Dermatol 2024; 51:301-306. [PMID: 37830399 DOI: 10.1111/1346-8138.17000] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/29/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
Dermatomyositis constitutes a heterogeneous group of autoimmune inflammatory conditions with a wide variety of clinical outcomes. The symptomatic heterogeneity carries skin, muscle, and joint manifestations; pulmonary and cardiac involvements; and concomitant malignancy. Any of these symptoms often appear at different combinations and time courses, thus posing difficulty in early diagnosis and appropriate treatment choice. Recent progress in laboratory investigations explored the identification of several myositis-specific autoantibodies (MSAs) and myositis-associated autoantibodies, allowing precise characterization for a clinical perspective of the disease. MSAs can be detectable in approximately 80% of patients with whole dermatomyositis, some of which closely reflect unique clinical features in the particular disease subset(s), including the distribution and severity of organ involvement, treatment response, and prognosis. However, only limited evidence has been available in dermatomyositis-associated panniculitis, mostly that in anti- melanoma differentiation-associated protein 5 antibody-positive disease. We present a rare case of a patients with dermatomyositis with extensive panniculitis on the trunk whose serum IgG autoantibodies reacted with both subunits of small ubiquitin-like modifier activating enzymes (SAEs), SAE1 and SAE2. The onset of panniculitis coincided with increased disease activity, including disease-related skin manifestations, fever, dysphagia, and muscle weakness in the extremities. These symptoms responded well to a high dose of systemic steroid, but even upon receiving a high-dose intravenous immunoglobulin, the panniculitic lesions and pruritic erythema flared with tapering of steroid dose, further requiring tacrolimus and mycophenolate mofetil to achieve disease remission. To our knowledge, this is the third reported case of anti-SAE autoantibody-positive dermatomyositis with panniculitis. We aim to extend the understanding of the current limitation and further perspective in the clinical management of the extremely rare skin manifestation associated with dermatomyositis.
Collapse
Affiliation(s)
- Misako Fujisaki
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hiroshi Kasamatsu
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kentarou Nishimura
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yasuyuki Yoshida
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yoriko Muneishi
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tomohisa Yamaguchi
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Risa Konishi
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Ichimura
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoko Okiyama
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Noritaka Oyama
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Minoru Hasegawa
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| |
Collapse
|
2
|
Lehnert NM, Behr J, Tufman A, Briegel I, Dinkel J. [Increasing dyspnoea and intermittent joint suffering]. Pneumologie 2023; 77:825-829. [PMID: 36958340 DOI: 10.1055/a-2016-7215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
In rheumatic diseases the possibility of pulmonary manifestation must always be considered and checked. Interstitial lung disease can often be fatal in these cases. In the presented case, the link between progressive dyspnea and newly occurring skin irritation is to be seen as particularly important. A good outcome can be achieved by immediate therapy with immunosuppression and plasmapheresis.
Collapse
Affiliation(s)
| | - Jürgen Behr
- Medizinische Klinik V, LMU Faculty of Medicine, München, Deutschland
| | - Amanda Tufman
- Medizinische Klinik V, LMU Faculty of Medicine, München, Deutschland
| | - Ignaz Briegel
- Internal Medicine - Pulomology, LMU, München, Deutschland
| | - Julien Dinkel
- Radiologie, 2. Asklepios Fachkliniken München-Gauting, München, Deutschland
| |
Collapse
|
3
|
Caro-Chang LA, Fung MA. The role of eosinophils in the differential diagnosis of inflammatory skin diseases. Hum Pathol 2023; 140:101-128. [PMID: 37003367 DOI: 10.1016/j.humpath.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
Eosinophils are known to be present in inflammatory skin diseases, but their diagnostic utility is not well established. Upon review of the published status of lesional eosinophils, several categories were identified. 1) Lesional eosinophils highly characteristic such that, in their absence, the pathologist may question the diagnosis. These include arthropod bite reactions and scabies, urticarial dermatitis, and other eosinophilic dermatoses. 2) Lesional eosinophils rare or absent, such that, in their presence, the pathologist may question the diagnosis. These include pityriasis lichenoides, graft versus host disease, and connective tissue disorders. 3) Lesional eosinophils variable and, while in some cases expected, are not required for diagnosis. These include drug reactions, atopic dermatitis and allergic contact dermatitis. 4) Lesional eosinophils variable and not expected but may be seen to a limited extent. These include lichen planus and psoriasis.
Collapse
|
4
|
Suzon B, Goulabchand R, Louis-Sidney F, Maria A, Najjari R, Chauvet E, Le Quellec A, Bessis D, Guilpain P. Subcutaneous tissue involvement in idiopathic inflammatory myopathies: Systematic literature review including three new cases and hypothetical mechanisms. Autoimmun Rev 2023; 22:103284. [PMID: 36736986 DOI: 10.1016/j.autrev.2023.103284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Involvement of subcutaneous tissue in idiopathic inflammatory myopathies (IIM) is poorly known. METHODS We conducted a systematic review of the literature regarding panniculitis and lipodystrophy/lipoatrophy in juvenile and adult IIM via PubMed/Medline, Embase and Scopus databases. Three local observations are included in this review. Epidemiological, clinical, paraclinical and therapeutic data were collected. RESULTS Panniculitis appears to be more common in adults than in juveniles. It was mainly localised in the upper and lower limbs. Panniculitis improved in most cases with steroids and panniculitis and myositis had a similar course in 83.3% and 72.2% of cases in juveniles and adults, respectively. Lipodystrophy appeared to be more frequent in juveniles and was only observed in dermatomyositis in both juveniles and adults. Lipodystrophy was mainly partial in juveniles and adults. The median time from myositis to the diagnosis of lipodystrophy was 6 years [0-35] and 2.5 years [0-10] in juveniles and adults, respectively. Lipodystrophy was associated with anti-TIF1 gamma auto-antibody positivity, a polycyclic/chronic course of myositis and the occurrence of calcinosis and might be an indicator of poor disease control. CONCLUSION Adipose tissue involvement, particularly lipodystrophy, occurs almost exclusively in dermatomyositis. The insidious onset and lack of awareness of the diagnosis may underestimate its prevalence. Larger studies are needed to identify possible risk factors in these patients, to better potential underlying pathophysiological process, in order to discuss potential therapeutic targets.
Collapse
Affiliation(s)
- Benoit Suzon
- Department of Internal Medicine, Martinique University Hospital, Fort-de-France, Martinique, France; EpiCliV Research Unit, University of French West Indies, Fort-de-France, Martinique, France
| | - Radjiv Goulabchand
- Department of Internal Medicine, Nîmes University Hospital, France; Institute for Regenerative Medicine and Biotherapy, INSERM U1183, Montpellier, France
| | - Fabienne Louis-Sidney
- EpiCliV Research Unit, University of French West Indies, Fort-de-France, Martinique, France; Department of Rheumatology, Martinique University Hospital, France
| | - Alexandre Maria
- Institute for Regenerative Medicine and Biotherapy, INSERM U1183, Montpellier, France; Department of Internal Medicine and Immuno-Oncologie (MedI(2)O), Montpellier University Hospital, France; Montpellier-1 University, Faculty of Medicine, France
| | - Redwann Najjari
- Department of Internal Medicine and Multi-Organic Diseases, Montpelier University Hospital, France
| | - Elodie Chauvet
- Department of Internal Medicine and Multi-Organic Diseases, Montpelier University Hospital, France
| | - Alain Le Quellec
- Department of Internal Medicine and Multi-Organic Diseases, Montpelier University Hospital, France
| | - Didier Bessis
- Department of Dermatology, Montpellier University Hospital, France
| | - Philippe Guilpain
- Institute for Regenerative Medicine and Biotherapy, INSERM U1183, Montpellier, France; Montpellier-1 University, Faculty of Medicine, France; Department of Internal Medicine and Multi-Organic Diseases, Montpelier University Hospital, France.
| |
Collapse
|
5
|
Kharghoria G, Ahuja R, Arava S, Jana M, Gupta V. Calcified dyspigmented plaques, discharging sinuses and guttate hypopigmentation: An unusual clinical presentation of clinically amyopathic dermatomyositis. Indian J Dermatol Venereol Leprol 2023; 89:90-94. [PMID: 36332085 DOI: 10.25259/ijdvl_997_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 07/01/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Geetali Kharghoria
- Department of Dermatology & Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Rhea Ahuja
- Department of Dermatology & Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Sudheer Arava
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Jana
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Vishal Gupta
- Department of Dermatology & Venereology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
6
|
Ginter DC, Ramien ML, Brundler MA, Swaney LC, Miettunen PM, Luca NJ. A rare case of suspected lupus erythematous panniculitis as the presenting skin feature of juvenile dermatomyositis: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221086317. [PMID: 35355853 PMCID: PMC8958673 DOI: 10.1177/2050313x221086317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Juvenile dermatomyositis is a rare autoimmune myopathy of childhood, associated with systemic vasculopathy, primarily affecting the capillaries. Panniculitis is seen histologically in about 10% of patients with dermatomyositis; however, its clinical presentation is rare, with only 30 cases presented in the literature to date. The histopathology overlaps with other inflammatory disease states, and is almost identical to the panniculitis seen in lupus erythematous panniculitis. In the cases with both panniculitis and dermatomyositis, skin and muscle inflammation is usually the first clinical manifestation. We present a case of a 16-year-old female with panniculitis as the initial presenting feature of juvenile dermatomyositis in the context of a prior diagnosis of indeterminate colitis.
Collapse
Affiliation(s)
- Dylan C Ginter
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michele L Ramien
- Division of Community Pediatrics, Department of Pediatrics, and Division of Dermatology, Department of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Marie-Anne Brundler
- Department of Pathology and Laboratory Medicine and Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Laura C Swaney
- Division of General Pediatrics, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Paivi Mh Miettunen
- Section of Pediatric Rheumatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Nadia Jc Luca
- Section of Pediatric Rheumatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
7
|
Fischer K, Aringer M, Steininger J, Heil J, Beissert S, Abraham S, Günther C. Improvement of cutaneous inflammation and panniculitis in dermatomyositis patients by the JAK-inhibitor baricitinib. Br J Dermatol 2022; 187:432-435. [PMID: 35318646 DOI: 10.1111/bjd.21252] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/16/2022] [Accepted: 03/20/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Kristina Fischer
- Department of Dermatology, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Martin Aringer
- Department of Medicine III, Rheumatology, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Julian Steininger
- Department of Dermatology, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Julius Heil
- Department of Dermatology, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Stefan Beissert
- Department of Dermatology, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Susanne Abraham
- Department of Dermatology, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Claudia Günther
- Department of Dermatology, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| |
Collapse
|
8
|
Takezawa K, Ueda‐Hayakawa I, Tanaka A, Son Y, Yamazaki F, Kambe N, Okamoto H, Fujimoto M. Panniculitis in dermatomyositis: Two cases with antitranscriptional intermediary factor‐1 antibody as myositis‐specific antibody and review of the literature. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2022. [DOI: 10.1002/cia2.12234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Kaori Takezawa
- Department of Dermatology Kansai Medical University Hirakata Japan
| | - Ikuko Ueda‐Hayakawa
- Department of Dermatology Kansai Medical University Hirakata Japan
- Department of Dermatology Osaka University Graduate School of Medicine Suita Japan
| | - Akihiro Tanaka
- Department of Rheumatology and Clinical Immunology Kansai Medical University Hirakata Japan
| | - Yonsu Son
- Department of Rheumatology and Clinical Immunology Kansai Medical University Hirakata Japan
| | | | - Naotomo Kambe
- Department of Dermatology Kansai Medical University Hirakata Japan
| | - Hiroyuki Okamoto
- Department of Dermatology Kansai Medical University Hirakata Japan
| | - Manabu Fujimoto
- Department of Dermatology Osaka University Graduate School of Medicine Suita Japan
| |
Collapse
|
9
|
Valenzuela A, Chung L. Subcutaneous calcinosis: Is it different between systemic sclerosis and dermatomyositis? JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2022; 7:7-23. [PMID: 35386947 PMCID: PMC8922676 DOI: 10.1177/23971983211053245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/27/2021] [Indexed: 02/03/2023]
Abstract
Calcinosis cutis is the deposition of insoluble calcium in the skin and subcutaneous tissues. It is a manifestation of several autoimmune connective tissue diseases, most frequently with systemic sclerosis and juvenile dermatomyositis, followed by adult dermatomyositis. Autoimmune connective tissue disease-associated calcinosis is of the dystrophic subtype, which occurs at sites of damaged tissue in the setting of normal serum calcium and phosphate levels. In juvenile dermatomyositis, calcinosis is considered a marker of ongoing disease activity and possibly inadequate treatment, while in adult dermatomyositis, it is a hallmark of skin damage due to chronic rather than active disease. Calcinosis is associated with long disease duration in systemic sclerosis and dermatomyositis, anti-polymyositis/sclerosis autoantibodies in systemic sclerosis and NXP-2 and melanoma differentiation-associated gene 5 in dermatomyositis. Calcinosis in systemic sclerosis occurs most frequently in the hands, particularly the fingers, whereas in dermatomyositis, it affects mainly the trunk and extremities. The primary mineral component of calcinosis is hydroxyapatite in systemic sclerosis and carbonate apatite in dermatomyositis. Calcinosis in dermatomyositis and systemic sclerosis share some pathogenic mechanisms, but vascular hypoxia seems to play a more important role in systemic sclerosis, whereas the release of calcium from mitochondria in muscle cells damaged by myopathy may be a primary mechanism contributing to dermatomyositis-related calcinosis. Multiple treatment strategies for dermatomyositis and systemic sclerosis-related calcinosis have been used with variable results. Early aggressive treatment of underlying myositis in patients with dermatomyositis may improve long-term outcomes of calcinosis. A better understanding of the pathogenesis of calcinosis is needed to improve treatment options.
Collapse
Affiliation(s)
- Antonia Valenzuela
- Division of Clinical Immunology and Rheumatology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA,Division of Immunology and Rheumatology, VA Palo Alto Health Care System, Palo Alto, CA, USA,Lorinda Chung, Division of Immunology and Rheumatology, Stanford University School of Medicine, 1000 Welch Rd Ste 203, MC 5755, Palo Alto, CA 94304, USA.
| |
Collapse
|
10
|
Anderson CW, Medina H, O'Brian R, Collamer A. When Tissue Is Not the Issue: A Case of Antisynthetase Syndrome Complicated by Disseminated Mycobacterium avium Complex. J Clin Rheumatol 2021; 27:S794-S797. [PMID: 32649407 DOI: 10.1097/rhu.0000000000001463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Caleb W Anderson
- From the Rheumatology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD
| | | | | | | |
Collapse
|
11
|
Giavedoni P, Podlipnik S, Fuertes de Vega I, Iranzo P, Mascaró JM. High-Frequency Ultrasound to Assess Activity in Connective Tissue Panniculitis. J Clin Med 2021; 10:4516. [PMID: 34640532 PMCID: PMC8509839 DOI: 10.3390/jcm10194516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022] Open
Abstract
Determining disease activity from clinical signs in patients with connective tissue panniculitis (CTP) is often challenging but is essential for therapeutic decision making, which largely relies on immunosuppressant treatment. High-frequency ultrasound (HFUS) may be useful in supporting such decisions by accurately determining CTP activity. This study aimed to investigate the accuracy of HFUS in identifying signs of CTP activity or inactivity and assess its usefulness in therapeutic decision making. A prospective cohort study of consecutive patients with biopsy-proven CTP receiving HFUS was conducted in a tertiary university hospital (2016-2020). HFUS was performed at inclusion and at each 3- or 6-month follow-up visit, depending on disease activity. Twenty-three patients with CTP were included, and 134 HFUSs were performed. In 59.7% (80) of the evaluations, the clinical presentation did not show whether CTP was active or not. In these cases, HFUS showed activity in 38.7% (31) and inactivity in 61.3% (49). In 71.25% (57) of the visits, HFUS was the determinant for therapeutic decisions. Further follow-up showed consistent clinical and HFUS responses in all unclear cases after treatment modification. HFUS appears to be a useful adjunct to the clinical examination for CTP to assess activity and make therapeutic decisions.
Collapse
Affiliation(s)
- Priscila Giavedoni
- Department of Dermatology, Institut Clínic de Medicina i Dermatologia, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (S.P.); (I.F.d.V.); (P.I.); (J.M.M.J.)
- Medical School, University of Barcelona, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Sebastian Podlipnik
- Department of Dermatology, Institut Clínic de Medicina i Dermatologia, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (S.P.); (I.F.d.V.); (P.I.); (J.M.M.J.)
- Medical School, University of Barcelona, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Irene Fuertes de Vega
- Department of Dermatology, Institut Clínic de Medicina i Dermatologia, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (S.P.); (I.F.d.V.); (P.I.); (J.M.M.J.)
- Medical School, University of Barcelona, 08036 Barcelona, Spain
| | - Pilar Iranzo
- Department of Dermatology, Institut Clínic de Medicina i Dermatologia, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (S.P.); (I.F.d.V.); (P.I.); (J.M.M.J.)
| | - José Manuel Mascaró
- Department of Dermatology, Institut Clínic de Medicina i Dermatologia, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (S.P.); (I.F.d.V.); (P.I.); (J.M.M.J.)
- Medical School, University of Barcelona, 08036 Barcelona, Spain
| |
Collapse
|
12
|
Kishida D, Ushiyama S, Shimojima Y, Ueno KI, Kurashina JI, Shirai T, Sekijima Y. Painless Panniculitis upon the Treatment of Clinically Amyopathic Dermatomyositis with Anti-MDA5 Antibody. Intern Med 2021; 60:2697-2700. [PMID: 33678748 PMCID: PMC8429278 DOI: 10.2169/internalmedicine.6931-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Panniculitis, a rare cutaneous manifestation in patients with dermatomyositis (DM), usually presents as a painful erythematous lesion. We herein report a 32-year-old woman with panniculitis that appeared as an indurated plaque without pain or redness after a 4-month episode of clinically amyopathic DM during treatment with prednisolone and tacrolimus. She experienced no pain; however, the firmness and extent gradually worsened. Based on our findings, including the histopathological results, DM panniculitis was diagnosed. Azathioprine was additionally administered, leading to remission. DM panniculitis can develop as a painless induration during immunosuppressive treatment, and azathioprine may be a useful treatment.
Collapse
Affiliation(s)
- Dai Kishida
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Japan
| | - Satoru Ushiyama
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Japan
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Japan
| | - Ken-Ichi Ueno
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Japan
| | - Jun-Ichi Kurashina
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Japan
| | - Takushi Shirai
- Department of Dermatology, Shinshu University School of Medicine, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Japan
| |
Collapse
|
13
|
Pinto AS, Santos FC, Dinis SP, Sampaio R, Ferreira JF, Vaz CC, Cabral MF. Painful erythematoviolaceous nodules in dermatomyositis. Rheumatology (Oxford) 2021; 60:1573-1574. [PMID: 33038256 DOI: 10.1093/rheumatology/keaa455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ana S Pinto
- Rheumatology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - Filipe C Santos
- Rheumatology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - Sara P Dinis
- Rheumatology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - Rita Sampaio
- Pathology Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Joana F Ferreira
- Rheumatology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal.,Faculty of Health Sciences, Universidade da Beira Interior, Covilhã, Portugal
| | - Cláudia C Vaz
- Rheumatology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal.,Faculty of Health Sciences, Universidade da Beira Interior, Covilhã, Portugal
| | - Maria F Cabral
- Faculty of Health Sciences, Universidade da Beira Interior, Covilhã, Portugal.,Dermatology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal
| |
Collapse
|
14
|
Connolly A, Gordon PA, Hannah J, Creamer D. The chameleon rash: a review of the polyphenotypic dermatoses of dermatomyositis. Clin Exp Dermatol 2021; 46:1016-1022. [PMID: 33882159 DOI: 10.1111/ced.14689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Abstract
Dermatomyositis (DM) is an autoimmune connective tissue disease that is included in the idiopathic inflammatory myopathies. Cutaneous manifestations are a prominent part of the condition: some skin signs in DM are common to most patients, while other signs are encountered infrequently. A number of features are pathognomic for DM. The demonstration of myositis-specific antibodies (MSAs) in DM has extended the ability to define phenotypic subgroups. It appears that the presence of certain MSAs confers susceptibility to specific clinical features, an association which reveals a serotype-phenotype relationship. In this review article we have provided a detailed summary of common and under-recognized cutaneous manifestations of DM.
Collapse
Affiliation(s)
- A Connolly
- Department of, Dermatology, King's College Hospital NHS Foundation Trust, London, UK
| | - P A Gordon
- Rheumatology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - J Hannah
- Rheumatology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - D Creamer
- Department of, Dermatology, King's College Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
15
|
Bitar C, Chan MP. Connective Tissue Diseases in the Skin: Emerging Concepts and Updates on Molecular and Immune Drivers of Disease. Surg Pathol Clin 2021; 14:237-249. [PMID: 34023103 DOI: 10.1016/j.path.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Cutaneous manifestations are common across the spectrum of autoimmune diseases. Connective tissue diseases manifesting in the skin are often difficult to classify and require integration of clinical, histopathologic, and serologic findings. This review focuses on the current understanding of the molecular and immune drivers involved in the pathogenesis of cutaneous lupus erythematosus, dermatomyositis, scleroderma/systemic sclerosis, and mixed connective tissue disease. Recent research advances have led to the emergence of new ancillary tools and useful diagnostic clues of which dermatopathologists should be aware to improve diagnostic accuracy for these diseases.
Collapse
Affiliation(s)
- Carole Bitar
- Department of Pathology, University of Michigan, 2800 Plymouth Road, NCRC Building 35, Ann Arbor, MI 48109, USA
| | - May P Chan
- Department of Pathology, University of Michigan, 2800 Plymouth Road, NCRC Building 35, Ann Arbor, MI 48109, USA.
| |
Collapse
|
16
|
Castillo RL, Femia AN. Covert clues: the non-hallmark cutaneous manifestations of dermatomyositis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:436. [PMID: 33842657 PMCID: PMC8033358 DOI: 10.21037/atm-20-5252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Dermatomyositis (DM) is a strikingly heterogenous disease characterized by a broad and ever-evolving spectrum of cutaneous manifestations that transcend the classic “hallmarks” defined by Peter and Bohan in 1975. Despite the increasing preponderance and ubiquity of autoantibody, radiologic, and electrophysiologic testing, the diagnosis of DM still hinges largely on prompt detection of cutaneous manifestations of this condition. While pathognomonic cutaneous features of DM are more readily recognizable, many patients present with subtle and/or atypical skin manifestations, and diagnosis of DM may require clinician identification of these cutaneous clues. In this review, we highlight several of the lesser-known skin manifestations of DM, specifically, panniculitis, diffuse subcutaneous edema, erythroderma, calcinosis, ulceration, flagellate erythema, Wong-type DM, gingival telangiectasias, and the ovoid palatal patch. We describe the clinical and histopathologic presentation of these cutaneous findings. While manifesting less frequently than the heliotrope rash, Gottron’s papules, and Gottron’s sign, these cutaneous clues are equally important for clinicians to recognize in order to facilitate timely diagnosis and early intervention.
Collapse
Affiliation(s)
- Rochelle L Castillo
- Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Alisa N Femia
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
17
|
Caractéristiques cliniques des myosites associées aux anticorps anti-NXP2 chez l’adulte : étude de 6 cas. Ann Dermatol Venereol 2020; 147:891-897. [DOI: 10.1016/j.annder.2020.09.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 09/10/2020] [Accepted: 09/25/2020] [Indexed: 11/17/2022]
|
18
|
Symmetrical Panniculitis in a Patient With Dermatomyositis. J Clin Rheumatol 2020; 26:e311. [DOI: 10.1097/rhu.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
19
|
Kuhn A. Characterizing clinicopathological and immunohistochemical findings in dermatomyositis panniculitis. J Eur Acad Dermatol Venereol 2020; 32:1231-1232. [PMID: 31211464 DOI: 10.1111/jdv.15149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Kuhn
- University Hospital Muenster, Muenster, Germany
| |
Collapse
|
20
|
Rungcharunthanakul A, Sampattavanich N. Polymyositis with antisynthetase syndrome presented with lobular panniculitis: A case report. Clin Case Rep 2019; 7:128-130. [PMID: 30656025 PMCID: PMC6333058 DOI: 10.1002/ccr3.1839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/27/2018] [Accepted: 09/01/2018] [Indexed: 11/17/2022] Open
Abstract
Panniculitis is rarely seen in polymyositis. To the best of our knowledge, we report the first case of panniculitis which precedes the antisynthetase syndrome.
Collapse
|
21
|
Miura T, Mori T, Ito T, Kikuchi N, Kato Y, Yamamoto T. Lupus erythematosus profundus in a patient with dermatomyositis. Clin Exp Dermatol 2018; 44:e47-e48. [PMID: 30593680 DOI: 10.1111/ced.13893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2018] [Indexed: 11/27/2022]
Affiliation(s)
- T Miura
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - T Mori
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - T Ito
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - N Kikuchi
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Y Kato
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - T Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| |
Collapse
|