frank100
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A 9 y/O BOY IS BROUGHT TO THE PHYSICIAN BEACUSE OF PROGRESSIVE WEAKNESS AND A PURPLE RED DISCOLORATION OVER HIS CHEEK AND UPPER EYELIDS OVER THE PAST 8 WEEKS. HIS SYMPTOMS BEGAN SHORTLY AFTER A CAMPING TRIP, AND HE NOW IS UNABLE TO CLIMB STAIRS, WALK LONG DISTANCES, COMB HIS HAIR, OR DRESS HIMSELF. HIS MOTHER SAYS THAT SHE WAS CAREFULL TO APPLY HIS SUNSCREEN TO THE TRIP AND CAN RECALL NO TICK BITES OR EXPOSURE TO POISONOUS PLANTS. HIS ONLY MEDICATION IS A TOPICAL CORTICOSTEROID FOR SEVERAL DRY SCATCHY PATCHES IN THE SKIN. HE APPEARS WEAK AND LETHARGIC. HE IS AT THE 75TH PERCENTILE FOR HEIGHT AND 25TH PERCENTILE FOR WEIGHT. HE HAS HAD NO CHANGE IN HIS WEIGHT SINCE HIS LAST EXAMINATION 9 MONTHS AGO. T:37.7, BP: 110/68, PULSE: 105, RESPIRATIONS: 28. EXAMINATION OF THE SKIN SHOWS A PURPLE-RED DISCOLORATION OVER THE CHEECKS AND EYELIDS, PERIORBITAL EDEMA, ERYTHEMATOUS PLAQUES AND SCALES OVER THE ELBOWS AND KNEES, AND FLAT TOPPED-RED PAPULES OVER ALL KNUCKLES. THERE IS GENERALIZED WEAKNESS AND ATROPHY OF THE PROXIMAL MUSCLES. WHICH OF THE FOLLOWING IS THE MOST LIKELY DIAGNOSIS?
A) DERMATOMYOSITIS
B) DUCHENE MUSCUALR DYSTROPHY
C) ECZEMA
D) LYME DISEACE
E) PSORIASIS
F) ROCKY MOUNTAIN SPOTTED FEVER
G) SEBORRHEA
H) SYSTEMIC LUPUS ERYTHEMATOUS
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| mazinger
Forum Guru
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Good question Frank and it leaves me clueless..
Looks like a dermatomiositis, but in a person so young?
Duchene is a chronic progressive muscular dystrophy. Patients usually become symptomatic (mild symptoms) at a very young age IE: two years of age. I have never read duchene's is asociated with dermatologic lesions, but you never now perhaps in a book out there it says is posible.
I dont know and cannot say..
but if this would be a real life situation I would pick dermato, dont ask why, just dermatomiositis, I dont know for sure...
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| drdiv
Forum Junior
Topics: 16
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every thing is pointing towards dermatomyositis
the rash, muscle weakness, gottrons patches (flat topped red papules) if i m not wrong
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| study_ing
Forum Fanatic
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dr div thats brilliant 
i was confused abt the age..but checked in an emedicine article.
dermatomyositis can occur at any age, though commonly it presents in the 5th or 6 th decade.
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| shumaila
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dermatomyositis
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| study_ing
Forum Fanatic
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here's what s in the case which points towards it..
1. heliotropic rash ( face, eyelids, and hands, and sometimes the skin above joints, including the knuckles, knees, elbows, etc. )
2.pattern of muscle weakness--The muscles first affected tend to be proximal
eventually inability to perform tasks like climbing stairs, lifting objects, and performing other manual tasks.
one feature which wasnt mentioned but is frequently associated is CALCINOSIS (calcium deposits under the skin)
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| juanma0
Forum Senior
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Agreed dermatomyositis. If this were a 56 yo woman there would be no doubt, but by changing the age group NBME makes us doubt.
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| cbenitesch
Forum Senior
Topics: 10
Posts: 141
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IŽll go for A) Juvenile Dermatomyositis.
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| webjeee
Forum Guru
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study_ing wrote:dr div thats brilliant i was confused abt the age..but checked in an emedicine article. dermatomyositis can occur at any age, though commonly it presents in the 5th or 6 th decade.
not 5-6th decade. it is in adult and child. harrison 16ed
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| chemamr
Moderator and PGY1
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agree with A
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| Guptashutosh
Forum Elite
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Posts: 354
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best test to diagnose it - Muscle biopy
t/t- steroids
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| Chrales
Forum Newbie
Topics: 2
Posts: 30
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I passed my Step 2 today and had EXACTLY this question. I also took dermatomyositis as it fits best. So remember this question
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