Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website http://www.jocmr.org

Case Report

Volume 10, Number 11, November 2018, pages 848-852

Fashionably Late: A Case of Delayed Cutaneous Manifestations in Juvenile Dermatomyositis

Figures

Figure 1.
Figure 1. Chest X-ray obtained on admission with unremarkable findings.
Figure 2.
Figure 2. MRI T2-weighted image showing increased signal activity and edema in patient’s proximal and distal lower extremities.
Figure 3.
Figure 3. Patient muscle biopsy with histopathology staining demonstrates characteristic perimysial reactivity, perifascicular atrophy, and perifascicular inflammation of lower extremities.

Tables

Table 1. Laboratory Results for the Patient During Admission to Facility C
 
Laboratory test (normal range)Patient value
AST, U/L (5 - 32)347
Aldolase, U/L (0.5 - 8.5)6.6
LDH, U/L (135 - 225)246
Creatinine kinase, IU/L (24 - 170)10,206
CRP, mg/dL (0 - 0.49)0.80
ESR, mm/h (0 - 20)38
WBC, (5.3 - 15) × 1037.7 × 103
Hemoglobin, g/dL (11 - 13.3)10.7

 

Table 2. Laboratory Results for the Patient
 
Laboratory testPatient result
Ab: antibody; VUS: variants of unknown significance.
Nuclear antibody panelSerum negative nuclear Ab
Extractable nuclear antibody panelSerum negative for ribonucleoprotein extractable nuclear Ab, Smith extractable nuclear Ab, SS-A Ab, and SS-B Ab
Myositis Ab 3 panelSerum negative for HIV-2 gp140 Ab, Jo-1 extractable nuclear Ab, PL-7 Ab, PL-12 Ab, EJ Ab, OJ Ab, Mi-2 Ab, signal recognition particle Ab, Ku Ab, U2 snRNP Ab, P155/140 AutoAb by WB, SS-A 52kD Ab IgG, PM-SCL extractable nuclear Ab, fibril U3 ribonucleoprotein Ab, and U1 small nuclear ribonucleoprotein Ab
Anti-HMGCR AbNegative
Chromosomal microarrayHeterozygous missense mutation in APOB gene and heterozygous deletion in LDHA gene
Myopathy rhabdomyolysis panelAbnormal VUS in ACAD9 associated with mitochondrial complex 1 deficiency, variant has not previously been reported
Muscular dystrophy panelNormal