Clinically amyopathic dermatomyositis during the COVID-19 pa
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An 84-year-old Japanese woman presented to our hospital with a month-long dry cough during the COVID-19 pandemic. She also had skin lesions on her fingers from 3 months prior; she attributed the rash to frequent hand washing and disinfection with alcohol for the prevention of COVID-19.

Physical examination revealed fine bilateral crackles on her chest, palmar papules on her fingers (inverse Gottron’s sign), Gottron’s sign and papules on elbows and knees, mechanic’s hand and facial rash; however, she had no heliotrope rash, shawl sign, holster sign or scalp involvement. A chest computed tomography (CT) scan showed bilateral ground-glass opacities with a subpleural distribution, similar to the findings of COVID-19.

The results of COVID-19 tests (antigen and reverse transcription-polymerase chain reaction) via nasopharyngeal swabs were negative. Blood tests revealed a leukocyte count of 3900/µL, a C-reactive protein level of 0.95 mg/dL, a creatine kinase level of 87 U/L and a ferritin level of 652.3 ng/mL. Furthermore, the titer of the anti-melanoma differentiation-associated gene 5 (MDA5) antibody was elevated at 2070 although antinuclear antibody and anti-aminoacyl-tRNA synthetase antibody were negative.

Consequently, the diagnosis of clinically amyopathic dermatomyositis (CADM) was confirmed and then administered oral prednisolone combined with tacrolimus. After the treatment, her symptoms, skin lesions and CT findings were gradually resolved.