Fasciitis in amyopathic dermatomyositis

Dermatomyositis is a disease frequently treated by rheumatologists and dermatologists due to prominent systemic features of inflammatory myositis, less common arthritis, and rare systemic vasculitis, in addition to the characteristic cutaneous manifestations of Gottron's papules over extensor surfaces, and a heliotrope rash over the eyelids. Patients with amyopathic dermatomyositis, a subset of dermatomyositis, display skin disease but no apparent muscle disease. This report describes an adult patient with the typical dermatomyositis rash with no weakness, normal muscle enzymes, and the unique finding of fasciitis without myositis on muscle biopsy, which correlated with a Magnetic Resonance Imaging (MRI) finding of a peripheral halo of intense signal around muscles on T2-weighted and fat suppression sequences. Although MRI finding of presumed fasciitis has been reported in juvenile-onset dermatomyositis, this is the first report of MRI evidence of fasciitis with pathological correlation in adult-onset dermatomyositis. We suggest that if MRI scans are ordered, as part of the work-up of dermatomyositis, a peripheral halo of increased signal should specifically be looked for, which could be interpreted as fasciitis based on this case report.