PMC10426407_01
The time course of treatment and states of illness.
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A 49-year-old male with a history of dermatomyositis and long-term use of glucocorticoids presented to our hospital with a painful indurated swelling in the anteromedial aspect of his thigh and a low-grade fever (maximum temperature of 37.9 degrees) persisting for 12 days (Figure 1). Physical examination revealed the presence of multiple subcutaneous nodules, scar tissue with hyperpigmentation, and local swelling and induration with redness and mild fluctuation in anteromedial thigh (Figures 1 and 2). He subsequently received a two-week course of amoxicillin (Figure 1).
(A and D): The cicatrix, fibrocollagenous nodules and multiple calcifications in abdomen and thighs. (B and E): The characteristic features of dermatomyositis: Heliotrope sign, V sign and Gottron sign. (C) (HEx40) and (F) (HEx100): Biopsy of the subcutaneous firm nodules in the trunk revealed localized collagen hyperplasia in the dermis, accompanied by significant mucin deposition, as well as adipose septal fibrosis and hyalinization in the subcutaneous adipose tissue, featuring lipomatous cysts and membranous changes, with a minor infiltration of lymphocytes in the dermis and subcutaneous adipose tissue. (G and H): T1-weighted MR images revealed high signal intensity in sartorius muscle (white arrows) and intermuscular space. (I): The chest CT scan identified subcutaneous calcified nodules (white arrow).
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Physical examination revealed the presence of multiple subcutaneous nodules, scar tissue with hyperpigmentation, and local swelling and induration with redness and mild fluctuation in anteromedial thigh (Figures 1 and 2). Of note, the patient presented with two distinct types of subcutaneous nodules: fibrocollagenous nodules, confirmed by pathology, and multiple calcifications, demonstrated on enhanced CT imaging (Figure 2). This could be related to the presence of membranous cystic changes and mild lymphocytic inflammation in the adipose lobules of skin biopsy (Figure 2).