Discussion: DM is part of a group of rare Idiopathic Inflammatory Myopathies associated with proximal muscle weakness and is differentiated by a violaceous, photosensitive rash classically appearing on the face, chest, and hands. Though it is often considered a disease of older age with peak incidence around age 50-59, a juvenile form also exists but is notably less common (1-10 versus 1-3.2 cases per million annually). DM may present with a variety of extra-muscular symptoms such as dysphagia, pulmonary, and cardiac involvement. Swallowing may be disrupted by involvement of the striated muscles in the oropharynx causing dysphagia and possible aspiration. Cardiac involvement, though rare, includes myocarditis, conduction abnormalities, arrhythmias, and even increased risk for myocardial infarction. Before the development of extensive cutaneous involvement, early DM may be difficult to distinguish from rhabdomyolysis as both classically involve weakness and elevated creatine kinases.
Conclusions: When faced with suspected rhabdomyolysis and extra-muscular symptoms in the acute setting, It is prudent for the hospitalist to broaden their differential and include this rheumatological pathology. Awareness of these extra-muscular manifestations can heighten clinical suspicion for DM, prevent misdiagnosis, and help expedite appropriate treatment.
To cite this abstract:Tiwari, R; Hall, ME; Lee, M . BREAKDOWN ON THE MAT: A RARE CASE OF EARLY ADULT-ONSET DERMATOMYOSITIS. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 756. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/breakdown-on-the-mat-a-rare-case-of-early-adult-onset-dermatomyositis/. Accessed September 19, 2019.