Dermatomyositis with anti-TIF1-γ antibodies
Published in the BMJ, the authors report the case of a 61-year-old male patient who presented with a 1-year history of swelling and pruritic erythema rash of the face and trunk. He reported associated myalgia and arthralgia of the knees and wrists. Two months before presentation, he developed muscle weakness of upper limbs and dyspnoea.

On review, he was noted to have unintentional weight loss (5 kg over 2 months) and increasing fatigue. His medical and family histories were unremarkable. His medications included omeprazole daily and vitamin B12 injections. Prior to presentation to our clinic, his general practitioner treated the patient with antihistamines, topical steroids (Elocom) and a short course of oral corticosteroid therapy which only provided temporary relief.

On review of vital signs, the patient was afebrile with a heart rate 86 bpm, blood pressure of 197/95 mm Hg, normal respiratory rate and an oxygen saturation of 98% on room air. On physical examination, the patient was noted to have a bilateral heliotrope oedema including upper and lower eyelids with erythematosquamous plaques.

Additionally, he was also noted to have pronounced neck swelling (collar of Stokes), diffuse rash on upper chest and back (shawl sign), discrete red papules over finger joints of both hands (Gottron’s papules) as well as over elbows and knees, and a mild periungual erythema.

Given the constellation of symptoms, dermatomyositis (DM) was highly suspected, and the patient was hospitalised for further investigations. The results of a skin biopsy (figure 2A,B) and electromyography were both in keeping with the diagnosis of DM.

Learning points
• Screening for cancer is essential when making a diagnosis of dermatomyositis (DM), especially in those with anti-transcription intermediary factor 1 gamma antibodies.

• It is important to maintain a close clinical follow-up and to check for cancer if symptoms of DM relapse.

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