Extensive subcutaneous calcification: a rare manifestation of dermatomyositis
Extensive subcutaneous calcification: a rare manifestation of dermatomyositis
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广泛的皮下钙化：皮肌炎的罕见表现
DOI：
10.1093/rheumatology/key395
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发表时间：
2019
期刊：
影响因子：
5.5
通讯作者：
Lin Tang
中科院分区：
文献类型：
--
作者：
Wenhan Huang;Lin Tang
DM的主要临床表现为近端骨骼肌无力和皮肤病变（heliotrope眶周水肿、Gottron丘疹和征象、机械手、披肩和v型征象、皮套征象）[1,2]。皮下钙化是一种相对罕见的成人皮肤病变的表现。一位28岁的男性，有2年的糖尿病病史，表现为对称性近端肌肉无力和皮肤出疹。体格检查发现掌指关节有紫斑。根据洛维特量表，近端肌力为5。实验室结果显示ESR和CRP升高。抗mda5抗体阳性。肌电图提示肌源性病变。MRI T2WI显示近端骨骼肌高信号。肌肉活检证实为糖尿病。该患者定期接受强的松龙和他克莫司治疗。他到我科就诊，抱怨过去5个月发现胸部和腋窝皮肤变硬。高分辨率CT示肺间质性病变，胸部及腋窝皮下脂肪间隙广泛点状高密度影（图1）。广泛的皮下钙化是糖尿病的一种罕见的表现，主要发生在青少年。风湿病学家必须注意抗mda5抗体成人患者的这种临床表现。
The main clinical manifestations of DM included proximal skeletal muscle weakness and cutaneous lesions (heliotrope periorbital oedema, Gottron papules and sign, mechanician hands, shawl and V-sign, and holster sign)[1, 2]. Subcutaneous calcification is a relatively rare manifestation of cutaneous lesions in adults. A 28-year-old man who had a 2-year history of DM presented with a symmetrical proximal muscle weakness and cutaneous eruption. Physical examination revealed violaceous plaques on the metacarpophalangeal joints. Proximal muscle strength was 5 according to the Lovett scale. Laboratory findings revealed elevated ESR and CRP.Anti-MDA5 antibodies were positive. Electromyography suggested myogenic lesions. MRI presented a high signal of proximal skeletal muscle on the T2-weighted image (T2WI). Muscle biopsy confirmed the diagnosis of DM. This patient was treated with prednisolone and tacrolimus regularly. He visited our department complaining of the hardened skin of his chest and armpit that had been detected in the past 5 months. High-resolution CT indicated interstitial lung disease and extensive punctate high-density shadows in the subcutaneous fat interval of his chest and armpit (Fig. 1). Extensive subcutaneous calcification is a rare manifestation of DM and mostly occurs in juveniles. Rheumatologists must be aware of this kind of clinical manifestation in adult patients with anti-MDA5 antibodies.