Journal of Education and Teaching in Emergency Medicine

ABSTRACT:Early diagnosis of rheumatologic diseases can improve patient outcomes. While clinical presentations of rheumatologic diseases can be vague, dermatomyositis (DM) has distinctive cutaneous findings that can clue in providers towards the diagnosis. This is a case report of a 49-year-old female who presented with progressive facial swelling, rash, and generalized myalgias for a month. She had seen several outpatient providers and had one other emergency department (ED) visit for these symptoms prior to her diagnosis. She had already trialed steroid creams, antibiotics, and oral steroids with no significant improvement in her symptoms. A physical exam revealed peri-orbital edema, rash on her face, chest, and arms, and proximal muscle weakness. Lab work was significant for an elevated creatine kinase (CK). Rheumatology was consulted and recommended admission for expedited work-up for DM. The DM diagnosis was confirmed, and the patient was given intravenous immunoglobulin (IVIG) and discharged on oral steroids with dermatology and rheumatology outpatient follow-up. This case exemplifies how DM is often a missed diagnosis. However, by recognizing the classic dermatologic findings, conducting a muscle strength exam, and obtaining additional laboratory studies such as CK, the diagnosis can be made more easily.