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    "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 &#40;Gottron&#39;s papules&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#44; facial erythema and heliotrope rash around the eyes&#44; neckline and thighs&#46; The areola on the left breast presented an ulcerated and infiltrated lesion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">We performed a biopsy of the skin lesions of the thigh&#46; The histological diagnosis was compatible with dermatomyositis&#46; The biopsy of the left breast showed an HER 2&#43; infiltrating ductal carcinoma&#46; In the laboratory tests&#44; the muscle enzymes were normal&#44; the myositis-specific antibodies were negative&#44; and the anti-TIF1 antibodies &#40;p155&#41; were positive&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Polarized light dermatoscopy revealed erythematous areas with punctate vessels on the knuckles&#44; periungual erythema and&#44; at the proximal level of the nail folds&#44; capillary loops arranged in parallel on a pink base&#46; We also observed irregular and thickened cuticles&#44; reported previously in the dermatomyositis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In the capillaroscopy&#44; the capillary density was irregular&#44; with numerous megacapillaries&#44; capillary dilatations&#44; winding vessels&#44; branched forms and a tuft of capillaries&#46; We also observed pericapillary halos&#44; punctate microhemorrhages and a slow capillary flow with individual thrombosed capillaries &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#46; These findings correspond to an active Cutolo sclerodermiform pattern&#44; described among other entities in dermatomyositis&#44; scleroderma and mixed connective tissue disease&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">With the diagnosis of paraneoplastic amyopathic dermatomyositis&#44; the patient was treated with systemic and topical corticosteroids&#44; as well as left mastectomy and chemotherapy&#44; resulting in a favorable outcome&#46; After almost 2 years of follow-up&#44; the patient has presented no recurrence of the symptoms&#46;</p></span>"
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Medicine in Images
DOI: 10.1016/j.rceng.2019.05.001
Paraneoplastic dermatomiositis: Skin lesions and capillaroscopy
Dermatomiositis paraneoplásica: lesiones cutáneas y capilaroscopia
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M.F. García-Gila,
Corresponding author
miguelgarciagil@outlook.com

Corresponding author.
, B. de Escalante Yangüelab, V. Lezcano Bioscaa
a Servicio de Dermatología y Venerología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
b Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain

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