Amyopathic dermatomyositis

A 54-year-old female patient with edema and erythema on both eyelids, hands , and neck was admitted to our clinic in December 1997. The lesions on the eyelids and neck appeared in September 1996, while the lesions on the hands appeared about 1 year later. The patient was using Simvastatyn 10 mg/day ( Zocor) for the hyper-lipidemia and she had also diet-regulated diabetes mel litus. Systemic examination findings were normal. Chest X-ray was normal. L aboratory findings were as follows: erythrocyte sedimentation rate 7 mm/h, ASO 200 IU/mL, C-reactive protein (negative), RF (negative), CBC, urine ana lysis, liver, kidney functions, blood sugar and electrolytes were normal. B lood lipids were slightly increased. Antinuclear antibodies, anti-dsDNA, an d VDRL were negative. Muscle enzyme values were normal (CPK, lactic dehydro genase, SOOT). On dermatologic examination, edema and violaceous erythema around the eyeli ds and V of neck were present. There were erythema, squam, and violet-color ed plane papules 0.5-1 cm in diameter on the metacarpals and extensor surfa ces of metacarpophalangeal joints. (Figs 1 and 2) Gottron's papule diagnosi s was made on the histopathologic examination of the biopsy of one of the p apules. There was no muscle weakness on the neurologic examination. Electromyograph ic (EMG) and quantitative EMG were normal. No pathology was observed in the gastroenterology consultation conducted to explore the existence of an int ernal malignancy. A gynecologist was also consulted as the patient had post menopausal bleeding; no pathology was observed in the vaginal smear, pelvic USG, and endometrial biopsy. The diagnosis of amyopathic dermatomyositis w as made after a detailed clinical and laboratory investigation, and histopa thologic examination. Chloroquine sulfate was started 250 mg/day for the cutaneous lesions in Jan uary 1998. The patient continued to take Simvastatyn 10 mg/day and to utili ze the diabetes mellitus diet. In March 1998, new erythematous and scaly le sions appeared on the knees bilaterally. In May 1998, the erythema and edem a on the eyelids have completely disappeared, and the hand and knee lesions have decreased. In June and September 1998, the EMG, quantitative EMG, and muscle enzyme values were normal. Our patient is still using chloroquine s ulfate 250 mg/day and a few papules still exist on the dorsum of both hands .