RESUMO
Dermatomyositis is a rare inflammatory condition affecting the skin, muscles, and joints. This series of anti-melanoma differentiation-associated gene 5 (anti-MDA5) autoantibody-positive cases highlights a possible link between anti-MDA5-positive dermatomyositis and COVID-19 exposure. A retrospective analysis was performed on anti-MDA5-positive dermatomyositis patients at a district general hospital between January 2021 and July 2023. Information was gathered on the clinical profiles, diagnostics, management, and disease course. The two cases are as follows: (1) A 44-year-old Asian female presented with back pain, tender proximal muscles, symmetrical synovitis, and Gottron's papules, which gradually began after a COVID vaccine and worsened after COVID-19 infection. Despite prompt management, she required finger amputation and a switch to immunomodulators to achieve arthritic disease control. (2) A 49-year-old Caucasian female presented with progressive dyspnea, polyarthralgia, dusky maculopapular rash, and oral ulcers, which began after a COVID vaccine and worsened after COVID-19 infection. Steroids and immunomodulators improved mobility and respiratory symptoms, while biologics subdued her skin symptoms. This case study provides growing evidence for an intriguing association between COVID-19 exposure and anti-MDA5 antibody-positive dermatomyositis. Further research is required to elucidate the underlying pathogenic mechanism. Early involvement of a multidisciplinary team, consideration of symptom variety, infection vigilance, and impact on quality of life are important factors for clinicians to consider when tailoring the management of these patients for optimized outcomes.
RESUMO
A white Caucasian woman in her 30s presented with an indurated lesion on her right upper arm. Panniculitis was clinically suspected. Antinuclear antibody testing was positive but incisional biopsy showed subcutaneous panniculitis-like T-cell lymphoma (SPTCL), although with some unusual features more in keeping with lupus. Initial treatment was with oral prednisolone and radiotherapy but with only partial response. A second biopsy was taken from an area of presumed residual disease. This displayed histological features that were much more typical of lupus erythematosus profundus (LEP) but with tiny foci suggesting concomitant microscopic areas of SPTCL. Immunofluorescence for IgM was positive. This case highlights the rare occurrence of a patient with overlapping clinical and pathological features of SCPTL and LEP. It emphasises the need for close clinicopathological correlation in the workup of patients with suspected panniculitis and the importance of careful pathological examination for features of both diseases.