Friday, November 21, 2008

Shades of Violet

A 45 year old female presents to your clinic complaining of weakness. She has trouble getting out of a chair or reaching for books on high shelves. She cannot identify when it started, but the weakness has been getting worse over the last few months. The weakness is symmetric and associated with mild muscle tenderness. On exam, you do not find any signs of muscle atrophy. Instead, you note the following:

Challenge: What's your diagnosis?

First two images are in the public domain; last two images shown under fair use.

3 comments:

Alex said...

dermatomyositis

Stephanie said...

dermatomyositis

Craig Chen said...

Wow...you guys are good! I didn't even know what this was until I started google imaging it.
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Shades of Violet

This is dermatomyositis, an idiopathic inflammatory myopathy characterized by immune complex deposition in the vessels (a complement mediated vasculopathy). The images show a heliotrope rash, a violaceous eruption over the upper eyelids with swelling (a pink-purple tint similar to the heliotrope flower); Gottron's sign, an erythematous scaly symmetric eruption over the MCP and IP joints or on the extensor surfaces of the extremities; the shawl sign (or V sign), a diffuse, flat erythematous lesion occuring over the chest and shoulders, exacerbated by UV light; mechanic's hands, a roughening and cracking of the skin at the tips and lateral aspects of the fingers (also seen in polymyositis). Associated diseases include interstitial lung disease, cancers, esophageal and cardiac disease.

Sources: UpToDate; www.nlm.nih.gov.