Indan Journal of Medical Research Indan Journal of Medical Research Indan Journal of Medical Research
  Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login  
  Home Print this page Email this page Small font sizeDefault font sizeIncrease font size Users Online: 4003       

   Table of Contents      
CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 60

Ulcerative Gottron: A sinister sign in dermatomyositis


Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry 605 006, India

Date of Submission07-Nov-2019
Date of Web Publication25-May-2021

Correspondence Address:
Vir Singh Negi
Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry 605 006
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_1921_19

Rights and Permissions

How to cite this article:
Shah S, Negi VS. Ulcerative Gottron: A sinister sign in dermatomyositis. Indian J Med Res 2020;152, Suppl S1:60

How to cite this URL:
Shah S, Negi VS. Ulcerative Gottron: A sinister sign in dermatomyositis. Indian J Med Res [serial online] 2020 [cited 2021 Aug 4];152, Suppl S1:60. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/60/316740

Patient's consent obtained to publish clinical information and images.


A 45 yr old male presented to the department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India, in May 2018 with fever, polyarthritis and rapidly progressive dyspnoea over seven months. One month prior to presentation, the patient noticed bilateral ulcerative lesions over the metacarpophalangeal joints, indicating ulcerative Gottron [Figure 1]A along with roughening of the radial border of the fingers, suggestive of Mechanic's hands. High-resolution computed tomography of the thorax suggested fibrotic non-specific interstitial pneumonitis (NSIP) pattern of interstitial lung disease (ILD) [Figure 1]B. Immunological workup was positive for anti-MDA-5 (melanoma differentiation associated protein-5) antibody. Diagnosis of rapidly progressive ILD (RP-ILD) with amyopathic dermatomyositis was considered, and treatment with high-dose steroids, intravenous immunoglobulin, cyclophosphamide and cyclosporine was initiated. Due to lack of response to the immunosuppressant, the patient developed pneumomediastinum [Figure 1]C leading to demise. Post-mortem lung biopsy revealed interstitial pneumonia without evidence of infection [Figure 1]D. The presence of ulcerative Gottron should alert physicians for the possibility of RP-ILD associated with MDA-5, requiring aggressive immunosuppression at early stages itself.
Figure 1: (A) Bilateral ulcerative Gottron lesions on the second metacarpophalangeal joints (red arrow). (B) High-resolution computed tomography thorax, axial section. Diffuse intra-lobular septal thickening in both lung fields (orange arrows). (C) Chest X-ray, pneumomediastinum (blue arrow) and subcutaneous emphysema (blue arrow). (D) Lung and respiratory mucosa with underlying interstitial fibrosis (black arrow) (H and E, ×40).

Click here to view


Acknowledgment: Authors acknowledge Dr B.H. Srinivas, department of Pathology, JIPMER, Puducherry, for providing histopathology image..

Conflicts of Interest: None.


    Figures

  [Figure 1]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Article Figures

 Article Access Statistics
    Viewed160    
    Printed0    
    Emailed0    
    PDF Downloaded29    
    Comments [Add]    

Recommend this journal