A Rash That Didn't Make Sense

November 4, 2016

It looked very much like dermatomyositis, but there were no signs of muscle weakness. What would be in your differential diagnosis?

Roll Up for the Medical Mystery Tour This slide show on a rash that didn't make sense is the first in a 4-part series by Dr Jonathan Schneider, a primary care physician with a special interest in dermatologic disease and a passion for turning over every stone in the pursuit of an elusive diagnosis. As Dr Schneider's medical mystery tour will highlight, sometimes going the extra mile takes you back to basics -- ie, a full, comprhehsive medical history and physical examination.To begin the case, advance to Slide 5.Read Dr Schneider's introductory bio to get a feel for his commitment to patient care; then, enjoy the ride.When you've complete this case, visit our large library of Dr Schneider's other intriguing cases.  Resources (in alphabetical order) Albal MB, Esposol EA, Vista EGS.  Amyopathic Dermatomyositis with Interstitial Lung Disease: A Rare Type of Dermatomyositis with Accelerated mortality rate. Rheumatol Curr Res 2013, S16. http://dx.doi.org/10.4172/2161-1149.S16-004  http://www.omicsonline.org/amyopathic-dermatomyositis-with-interstitial-lung-disease-rare-type-of-dermatomyositis-accelerated-mortality-rate-2161-1149.S16-004.pdfAmyopathic Dermatomyositis – Genetic and Rare Disease Information Center, National Institutes of Health.  (updated 2013)  https://rarediseases.info.nih.gov/diseases/9907/amyopathic-dermatomyositisBailey EE Fiorentino DF. Amyopathic Dermatomyositis: Definitions, Diagnosis, and Management.  Curr Rheumatol Rep. 2014;16: 465. http://link.springer.com/article/10.1007/s11926-014-0465-0el-Azhary RA, Pakzad SY. Amyopathic dermatomyositis: Retrospective review of 37 cases. JAAD. 2002;46:560–565Galimberti F, Li Y, Fernandez AP. Clinically amyopathic dermatomyositis: clinical features, response to medications and malignancy-associated risk factors in a specific tertiary-care-centre cohort. Br J Dermatol. 2016;174:158-64. doi: 10.1111/bjd.14227. Epub 2015 Dec 1. https://www.ncbi.nlm.nih.gov/pubmed/26490490Gerami P , Schope JM, McDonald L, Walling HW, Sontheimer RD. A systematic review of adult-onset clinically amyopathic dermatomyositis (dermatomyositis sine myositis): A missing link within the spectrum of the idiopathic inflammatory myopathies. J Am Acad Dermatol 2006 Apr; 54:597-613. https://www.ncbi.nlm.nih.gov/pubmed/16546580?access_num=16546580&link_type=MED&dopt=Abstract (See also: Callen JP. What is clinically amyopathic dermatomyositis? Comment in: NEJM Journal Watch, May 23, 2006. http://www.jwatch.org/jd200605230000001/2006/05/23/what-clinically-amyopathic-dermatomyositis)Pietrosanti M, et al. Clinically Amyopathic Dermatomyositis: Case Report and Review of the Literature. Int Trends Immun.2013;1.  http://researchpub.org/journal/iti/number/vol1-no3/vol1-no3-9.pdfSaoud B, Allali F, Hajjaj-Hassouni N. Amyopathic dermatomyositis. Joint Bone Spine. 2006;73:318-20 https://www.researchgate.net/publication/7512470_Amyopathic_dermatomyositisSultan SM, Isenberg DA. Re-classifying myositis 30 years on from Bohan and Peter. Rheumatology. 2010;49: 831-833. doi: 10.1093/rheumatology/kep355. http://rheumatology.oxfordjournals.org/content/49/5/831.full