Correspondence |

Antimalarial Myopathy in Amyopathic Dermatomyositis

Galen Foulke, MD; Jennifer Baccon, MD, PhD; James G. Marks, MD; Jennie T. Clarke, MD
Arch Dermatol. 2012;148(9):1100-1101. doi:10.1001/archdermatol.2012.1711.
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Amyopathic dermatomyositis (ADM) is a variant of dermatomyositis (DM) lacking myopathy. Though it has been argued that patients with ADM are in a “premyopathic stage” of DM, several studies show that a minority of patients with ADM develop myopathy.13 Failure to recognize ADM may lead to inadequate treatment and screening for DM-associated malignant neoplasm and interstitial lung disease.3 The development of weakness in ADM may not represent progression to classic DM, and a thorough evaluation is necessary to determine its cause.

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Figure 1. The patient presented with classic cutaneous findings of dermatomyositis including the violet-pink, slightly scaly, poikilodermic periorbital heliotrope rash.

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Figure 2. Vastus lateralis biopsy specimen. A, The granular stippling and scattered atrophic fibers can be seen in this hematoxylin-eosin–stained section, but no perifascicular atrophy is present (original magnification ×400). B, Electron microscopy demonstrates curvilinear bodies (arrow) and membranous whorls. Curvilinear bodies, which are lysosome-derived cytoplasmic inclusions, have only been described in chloroquine toxic effects and in the lipid-storage disorder ceroid lipofuscosis.4




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