PMC8565688_01
Heliotrope rash: purple-reddish rash on the upper eyelids accompanied by eyelid swelling (a); Ulcer of the right elbow (usually indicates significant vasculopathy in JDM) (b); Gottron's papules and signs: papulosquamous and macular erythematous lesion over the dorsal surface of Knuckles (c); Contracture of joints (rigidity of the joints due to inflammation and hardening of muscles) (d)
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Further skin inspection showed thick and pale papules over the proximal and distal interphalangeal joints (Gottron's papules and signs) as shown in Figure 1c. Musculoskeletal examination revealed contracture of the knees and elbows (Figure 1d), the patient was unable to get up from supine position and had difficulty in raising her arms when seated up.
Juvenile dermatomyositis: skeletal muscle biopsy with characteristic perivascular mononuclear cell infiltrate (HE, x400)
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The muscle biopsy showed foci of perivascular lymphocytic infiltration and plasma cells with degeneration of muscle fascicles in tandem with juvenile dermatomyositis (Figure 2).