A 7 year-old male child presented with insidious onset
of symmetric proximal muscle weakness over about 6 months and
Gottron’s papules (Fig.1). His serum aldolase was 9.8 units (normal
0–7.6 units). Other investigations including other muscle enzymes were
essentially normal. His MRI showed hyperintensities in bilateral
anterolateral, medial and posterior thigh and pelvic girdle muscles
confirming the diagnosis of dermatomyositis (DM).
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Fig.1 Hands showing Gottron’s Papules. |
Gottron’s papules, named after Heinrich Adolf Gottron
(1890-1974), a German dermatologist, are a late manifestation of the
disease but are considered pathognomonic of DM. These are symmetric, lacy,
pink to violaceous, raised or macular areas typically found on the dorsal
aspect of metacarpophalangeal and interphalangeal joints, elbows, patellae
and medial malleoli.They represent cutaneous vasculitis and in severe
cases may ulcerate. Approximately 60% to 80% of DM patients have Gottron’s
papules sometime during the course of the disease.
