SHM Converge Scientific Abstract ePoster Gallery-A Case of Anti-Melanoma Differentiation Associated Gene 5 Dermatomyositis

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This case describes a 25-year-old woman with a history of Raynaud’s syndrome and cutaneous lupus who presented to the emergency department with bilateral hand ulcerations, facial edema, joint pain, weakness, weight loss, and worsening painful skin lesions. Exam showed periorbital rash, ulcerating lesions on the hands and elbows, palmar pustules, and inflammatory changes over both elbows. She had multiple recent hospitalizations for presumed infected skin ulcers and had already undergone elbow debridement, bursectomy, and prolonged IV antibiotics.<br /><br />Initial workup showed elevated inflammatory markers and a positive ANA, but other autoimmune and infectious studies were largely negative. Imaging of the elbows demonstrated soft tissue swelling and ulceration, with MRI showing inflammatory/reactive changes consistent with cellulitis, superficial fasciitis, and mild myositis. Infectious disease treated her with vancomycin and cefepime, while rheumatology raised concern for amyopathic dermatomyositis and ordered a myositis panel.<br /><br />The patient was later rehospitalized for worsening upper-extremity lesions. CTA ruled out interstitial lung disease, an important complication of anti-MDA5 dermatomyositis. The myositis panel returned positive for anti-MDA5 antibodies, confirming the diagnosis. She was started on IVIG, continued on monthly IVIG and daily prednisone, and later added mycophenolate mofetil, with clinical improvement in ulcerations.<br /><br />The discussion emphasizes that anti-MDA5 dermatomyositis can be difficult to diagnose because it has a broad differential and may present with prominent skin disease rather than muscle weakness. It carries high mortality due to rapidly progressive ILD, so delays in diagnosis can be dangerous. This case highlights the importance of early recognition and shows successful treatment with IVIG and mycophenolate mofetil in a patient without ILD.

Asset Subtitle

Rina Joshi

Meta Tag

Author List John H. Oneill Jr., Maryah Mansoor, Rina Joshi

Category Clinical Vignettes

Concept Anti-MDA5 Dermatomyositis

Concept Anti-MDA5 Antibody

Concept Rapidly Progressive Interstitial Lung Disease

Concept Skin ulcer

Concept Dermatomyositis

Distinguished Non-Finalist

Presenter Organization Christiana Care

Presenting Author Rina Joshi

Track Adult

Keywords

anti-MDA5 dermatomyositis

amyopathic dermatomyositis

cutaneous ulcers

Raynaud syndrome

cutaneous lupus

myositis panel

intravenous immunoglobulin

mycophenolate mofetil

interstitial lung disease

skin lesions

Anti-MDA5 Dermatomyositis

Anti-MDA5 Antibody

Rapidly Progressive Interstitial Lung Disease

Skin ulcer

Dermatomyositis