Elderly woman with purple rash on eyelids
Fred Bernardes Filho, Breno Nery
The Pan African Medical Journal. 2018;30:80. doi:10.11604/pamj.2018.30.80.15037

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Elderly woman with purple rash on eyelids

Cite this: The Pan African Medical Journal. 2018;30:80. doi:10.11604/pamj.2018.30.80.15037

Received: 01/02/2018 - Accepted: 19/05/2018 - Published: 29/05/2018

Key words: Dermatomyositis, connective tissue disease, creatine kinase

© Fred Bernardes Filho et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available online at: http://www.panafrican-med-journal.com/content/article/30/80/full

Corresponding author: Fred Bernardes Filho, Dermatology Division, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Emergency Department, Hospital Imaculada Conceição da Sociedade Portuguesa de Beneficência, Ribeirão Preto, São Paulo, Brazil (f9filho@gmail.com)


Elderly woman with purple rash on eyelids

Fred Bernardes Filho1,2,&, Breno Nery3

 

1Dermatology Division, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil, 2Emergency Department, Hospital Imaculada Conceição da Sociedade Portuguesa de Beneficência, Ribeirão Preto, São Paulo, Brazil, 3Department of Neurosurgery, Hospital Imaculada Conceição da Sociedade Portuguesa de Beneficência, Ribeirão Preto, São Paulo, Brazil

 

 

&Corresponding author
Fred Bernardes Filho, Dermatology Division, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Emergency Department, Hospital Imaculada Conceição da Sociedade Portuguesa de Beneficência, Ribeirão Preto, São Paulo, Brazil

 

 

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A 62-year-old woman presented with purple rash on her eyelids, erythematous and violaceous rash over the lateral thighs, and proximal muscle weakness. On physical examination, she had a pulse rate of 90/min and blood pressure of 138/90 mmHg. Dermatological examination showed reddish-purple rash on the upper eyelids and violaceous erythema on the lateral surface of the thighs. Laboratory testing was remarkable for elevated creatine kinase at 4,460. White blood cells, liver enzymes, electrolytes, antinuclear antibodies, cranial, abdominal and thorax tomography were unremarkable. Serology tests for hepatitis B, and C, HIV, syphilis, spotted fever and Lyme borreliosis were negative. The diagnosis of dermatomyositis was performed and the treatment was started with prednisone 1mg/kg daily. Dermatomyositis is a connective tissue disease that combines myopathy and distinctive skin manifestations. Creatine kinase is the muscle enzyme most widely used to diagnose polymyositis/dermatomyositis and to follow therapeutic response. There are hallmark cutaneous signs described for dermatomyositis that may or may not parallel the inflammatory myopathy. These include: violaceous to dusky erythematous rash with or without edema on periorbital skin (heliotrope rash), scaly erythematous eruption on the dorsum of hands, metacarpophalangeal joints, proximal interphalangeal joints, knees and elbows (Gottron's sign), confluent macular violaceous erythema on the anterior neck and chest ("V" sign) and confluent macular violaceous erythema present on the lateral side of hip and thighs (Holster sign). The cutaneous disease in dermatomyositis is photodistributed and often photoaggravated. The importance of recognizing dermatological signs in dermatomyositis is due to the cutaneous lesions precede muscle disease in one third to one half of patients.

 

Figure 1: A) a reddish-purple rash on the upper eyelids (Heliotrope rash); B) violaceous erythema on the lateral surface of the left thigh (Holster sign); C) confluent macular violaceous erythema on the lateral side of right thigh (Holster sign)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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Keywords

Dermatomyositis
Connective tissue disease
Creatine kinase

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