PMC4910142_01
Physical findings suggestive of clinically amyopathic dermatomyositis. a) facial erythema and heliotrope rash; b) erythema over the V area of the neck; c) scaly erythema with ulceration over the elbow; d) Gottron's sign.
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Her physical examination revealed a fever (38.3  C), facial erythema and heliotrope rash (Fig. 1a), erythema over the V area of the neck (Fig. 1b), scaly erythema with ulceration over the elbow (Fig. 1c), knee, and dorsum of her hands (Gottron's sign) (Fig. 1d), and skin thickening on the sides of her fingers (mechanic hands).
Chest computed tomography. Peribronchovascular ground-glass opacities and bilateral subpleural reticular opacities.
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A chest computed tomography (CT) scan showed peribronchovascular ground-glass opacities and bilateral subpleural reticular opacities (Fig. 2).
Histopathological findings in lung biopsy specimen. a) diffuse involvement in secondary lobule with mild peripheral accentuation [haematoxylin-eosin (HE) stain]; b) accumulation of foamy macrophages accentuated in the periphery of the lobule along with a few neutrophils [HE stain]; c) no hyaline membrane or extensive fibrin are seen, but rare and scant airspace fibrin is found [HE stain]; d) Scattered Masson bodies as organizing pneumonia incorporating surrounding alveolar ducts in less than 20% of area [Elastica van Gieson stain]. Scale bars: 900 mum (a), 200 mum (b, c, d).
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The lesion was characterized by diffuse mild interstitial fibrosis and inflammatory cell infiltration mostly of lymphocytes, and the changes were homogeneous, as in a nonspecific interstitial pneumonia (NSIP) pattern (Fig. 3a). There were accumulations of foamy macrophages and a few neutrophils in the airspace (Fig. 3b), and subacute changes such as scant airspace fibrin and scattered Masson bodies as a minor component of the pathology (Fig. 3c, d).