case_images: PMC11176935_01
case_images: Use of and access to existing and other proposed diagnostic criteria for JDM [3]
case_images: OC-14-05-t-001.jpg
case_images: PMC11176935_01_OC-14-05-t-001.jpg
case_images: T1
case_images: On general examination, there was presence of erythematous macular papular lesions over the neck (Figure 1b (Fig. 1)), lower back, extensor surface of arm, shin of tibia and small joints of hands. On ophthalmic examination, the patient had heliotrope rashes in the form of violaceous discolouration along with mild swelling over the upper lids of both eyes (Figure 1a (Fig. 1)).
case_images: (a) Violaceous eruptions present around eyelids - heliotrope rash; (b) cutaneous lesions in healing stage
case_images: OC-14-05-g-001.jpg
case_images: PMC11176935_01_OC-14-05-g-001.jpg
case_images: F1
case_images: Multiple Purtscher flecken (Figure 2 (Fig. 2)) and polygonal areas of retinal whitening were present around peripapillary area in zone 1 (4 DD radius area around the optic nerve head).
case_images: Fundus photograph showing multiple Purtscher flecken, scattered foci of cotton wool spots, intra retinal haemorrhages, pseudo-cherry red spot with macular oedema and engorged retinal vessels
case_images: OC-14-05-g-002.jpg
case_images: PMC11176935_01_OC-14-05-g-002.jpg
case_images: F2
case_images: However, magnetic resonance imaging (MRI) (Figure 3 (Fig. 3)) showed diffuse oedema in the muscle of bilateral gluteal region and thigh, appearing hyperintense on T2W and STIR images and hypointense on T1 W sequence, suggesting the possibility of dermatomyositis.
case_images: MRI of pelvis and thigh shows bilateral diffuse oedema in the muscle of the bilateral gluteal region and thigh suggestive of dermatomyositis
case_images: OC-14-05-g-003.jpg
case_images: PMC11176935_01_OC-14-05-g-003.jpg
case_images: F3
case_images: A subsequent right thigh muscle (vastus lateralis) biopsy (Figure 4 (Fig. 4)) confirmed variation in muscle fibre size, perifascicular atrophy and perivascular chronic inflammation composed of lymphocytes and plasma cells, consistent with an inflammatory myopathy. 