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CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 238

Extensive ulcerative lesions in juvenile dermatomyositis


1 Division of Pediatric Rheumatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110 029, India
2 Department of Plastic, Reconstructive & Burn Surgery, All India Institute of Medical Sciences, New Delhi, 110 029, India

Date of Submission20-Nov-2019
Date of Web Publication25-May-2021

Correspondence Address:
Narendra Kumar Bagri
Division of Pediatric Rheumatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_2410_19

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How to cite this article:
Bagri NK, Manas RK. Extensive ulcerative lesions in juvenile dermatomyositis. Indian J Med Res 2020;152, Suppl S1:238

How to cite this URL:
Bagri NK, Manas RK. Extensive ulcerative lesions in juvenile dermatomyositis. Indian J Med Res [serial online] 2020 [cited 2021 Aug 4];152, Suppl S1:238. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/238/316851

The child's assent and parents' consent obtained to publish clinical information and image.


A 16 yr old male child presented to the department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India, in February 2017 with fever, progressive muscular weakness, polyarticular arthritis and skin ulcers for nine months. On examination, he was emaciated (body mass index of 15.4) with Gottron's papules [Figure 1], truncal and limb muscle weakness along with multiple skin ulcers, with largest one overlying scapula [Figure 2]A. Investigations revealed raised inflammatory markers and hyperintensities of the thigh muscles on magnetic resonance imaging, and a diagnosis of juvenile dermatomyositis was made. Immunosuppressive therapy using intravenous immunoglobulin, steroids and weekly methotrexate was initiated in addition to an interim biological dressing [Figure 2]B. The steroids were tapered over 18 months and complete recovery of muscular weakness and healing of ulcers were observed at 10 months [Figure 2]C.
Figure 1: Gottron's papules over dorsal aspect of the metatarsophalangeal and proximal inter-phalangeal joints.

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Figure 2: (A) Extensive vasculitic ulcers over the back. (B) Biological dressing using allograft from father covering the larger ulcer. (C) Healed ulcers at follow up after immunosuppressive therapy.

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Conflicts of Interest: None.


    Figures

  [Figure 1], [Figure 2]



 

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