Pankaj Das, Anuj Bhatnagar, Smriti Sharma, Varghese Koshy, Vinay Gera, Lekshmi Priya Krishnan, Rahul Thombre, Nishu Bala
European Journal of Rheumatology - 2026;13(1):1-3
A 49-year-old female presented with redness and scaling of scalp of 2 years duration. It was associated with photosensitivity and difficulty getting up from squatting position since 4 months. Clinical examination revealed diffuse uniform erythema affecting scalp and its margins at forehead, temples and posterior aspect of neck. There was patchy scaling present at the nape of the neck. The dorsum of the proximal and distal inter-phalangeal joints showed erythematous lesions suggestive of Gottron's papules. Nail fold capillaroscopy revealed dilated tortuous capillaries with hemorrhages. Manual muscle testing (MMT) of the hip muscles revealed grade 3 weakness of the hip flexors. Magnetic resonance imaging (MRI) of hip and both thighs showed diffuse hyperintensity on T2-weighted images in gluteus maximus and quadriceps along with subcutaneous edema. In myositis profile, Jo-1 was positive (+++) with raised serum creatine kinase. There was pulmonary arterial hypertension (PAH) on 2D echocardiography. Computed tomography of chest revealed a non-specific interstitial pneumonitis (NSIP) pattern of interstitial lung disease (ILD). She was diagnosed as a case of dermatomyositis with PAH and ILD and was started on tapering doses of tablet prednisolone from 0.5 mg per kg per day and tablet mycophenolate mofetil 500 mg twice daily. For PAH, she was started on once-daily doses of tablet tadalafil 40 mg and tablet bosentan 125 mg. Seborrhoeic dermatitis pattern of involvement in dermatomyositis is a rare presentation. Scalp involvement in dermatomyositis is often overlooked or misdiagnosed; a high index of suspicion for dermatomyositis is hence necessary.
