Medicine in Images
Paraneoplastic dermatomiositis: Skin lesions and capillaroscopy
Dermatomiositis paraneoplásica: lesiones cutáneas y capilaroscopia
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García-Gil, B. de Escalante Yangüela, V. Lezcano Biosca" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M.F." "apellidos" => "García-Gil" "email" => array:1 [ 0 => "miguelgarciagil@outlook.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "B." "apellidos" => "de Escalante Yangüela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "V." "apellidos" => "Lezcano Biosca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología y Venerología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatomiositis paraneoplásica: lesiones cutáneas y capilaroscopia" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1748 "Ancho" => 1500 "Tamanyo" => 314358 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 77-year-old woman with asthenia that started 4 months earlier presented erythematous papules on the bony prominences of both hands (Gottron's papules) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), facial erythema and heliotrope rash around the eyes, neckline and thighs. The areola on the left breast presented an ulcerated and infiltrated lesion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">We performed a biopsy of the skin lesions of the thigh. The histological diagnosis was compatible with dermatomyositis. The biopsy of the left breast showed an HER 2+ infiltrating ductal carcinoma. In the laboratory tests, the muscle enzymes were normal, the myositis-specific antibodies were negative, and the anti-TIF1 antibodies (p155) were positive.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Polarized light dermatoscopy revealed erythematous areas with punctate vessels on the knuckles, periungual erythema and, at the proximal level of the nail folds, capillary loops arranged in parallel on a pink base. We also observed irregular and thickened cuticles, reported previously in the dermatomyositis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C).</p><p id="par0020" class="elsevierStylePara elsevierViewall">In the capillaroscopy, the capillary density was irregular, with numerous megacapillaries, capillary dilatations, winding vessels, branched forms and a tuft of capillaries. We also observed pericapillary halos, punctate microhemorrhages and a slow capillary flow with individual thrombosed capillaries (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). These findings correspond to an active Cutolo sclerodermiform pattern, described among other entities in dermatomyositis, scleroderma and mixed connective tissue disease.</p><p id="par0025" class="elsevierStylePara elsevierViewall">With the diagnosis of paraneoplastic amyopathic dermatomyositis, the patient was treated with systemic and topical corticosteroids, as well as left mastectomy and chemotherapy, resulting in a favorable outcome. After almost 2 years of follow-up, the patient has presented no recurrence of the symptoms.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-02-06" "fechaAceptado" => "2019-02-19" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Gil MF, de Escalante Yangüela B, Lezcano Biosca V. Dermatomiositis paraneoplásica: lesiones cutáneas y capilaroscopia. Rev Clin Esp. 2020;220:384–385.</p>" ] ] "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1748 "Ancho" => 1500 "Tamanyo" => 314358 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000022000000006/v2_202102250828/S2254887419301237/v2_202102250828/en/main.assets" "Apartado" => array:4 [ "identificador" => "71811" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Medicine in images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022000000006/v2_202102250828/S2254887419301237/v2_202102250828/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419301237?idApp=WRCEE" ]
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