Vesicular dermatomyositis presenting without any underlying malignancy

A female in her early 50s presented with proximal muscle weakness, joint pain and a progressive rash following an upper respiratory infection. Physical examination revealed the hallmark features of dermatomyositis, including a shawl distribution and v-neck rash, with unique vesicular changes. Laboratory findings demonstrated markedly elevated creatine phosphokinase, C-Reative Protein, liver function test [Aspartate aminotransferase greater than Alanine aminotransferase], aldolase and antinuclear antibody titers. A skin biopsy confirmed the diagnosis of dermatomyositis. Treatment with systemic corticosteroids resulted in significant clinical improvement. This case emphasises the importance of recognising atypical features of dermatomyositis and highlights the diagnostic challenges posed by overlapping clinical features with other conditions.