Panniculitis as an Initial Presentation of Dermatomyositis: A Case Report

Area of Science:

• Rheumatology
• Dermatology
• Neurology

Background:

• Dermatomyositis is an idiopathic inflammatory myopathy.
• Key features include proximal muscle weakness, elevated muscle enzymes, and characteristic skin manifestations.
• Dermatological signs like Gottron's papules and heliotrope rash are typically pathognomonic.

Observation:

• Panniculitis, an inflammation of subcutaneous fat, is a rare finding in dermatomyositis.
• This report details a 37-year-old female patient whose dermatomyositis presented exclusively with panniculitis.
• The diagnosis of dermatomyositis was significantly delayed, exceeding one year, due to the atypical presentation.

Findings:

• The patient's sole presenting symptom was panniculitis, mimicking other subcutaneous conditions.
• Despite the absence of classic dermatomyositis dermatological signs, the diagnosis was confirmed.
• This case underscores the variability in clinical presentation of dermatomyositis.

Implications:

• Highlights the diagnostic challenge posed by rare presentations of dermatomyositis.
• Emphasizes the need for a high index of suspicion for dermatomyositis even with atypical symptoms like isolated panniculitis.
• Suggests that earlier consideration of dermatomyositis in cases of unexplained panniculitis could improve patient outcomes.