Abstract:

Dermatomyositis is an autoimmune connective tissue disease which can present with muscle weakness and various skin manifestations including a heliotrope rash, gottrons papules, shawl sign, cuticular changes, and rarely mucinous papules. Eosinophils have long been considered an infrequent histopathologic finding in autoimmune connective tissue disease; however, a recently published paper by Khanna et al. has suggested that eosinophils may be more common in dermatomyositis than previously observed. Herein we report a 53-year-old female with a known diagnosis of dermatomyositis with anti-NXP-2 positivity. She presented with progressive juicy pink papules on the upper, lower back and bilateral upper extremities with significant pruritus. Her lesions were biopsied at 2 different time points. The initial biopsy from a more pruritic area on the upper back demonstrated a superficial perivascular dermatitis with eosinophils (12 eosinophils per HPF), favoring a drug eruption. Whereas the subsequent biopsy of a similar appearing lesion with less pruritus from the left arm revealed a more classic interface dermatitis with increased mucin and an absence of eosinophils, consistent with dermatomyositis. Retrospectively, a mucin stain was performed on the first biopsy demonstrating an increase in the upper dermis. Direct immunofluorescence was unrevealing, no peripheral eosinophilia or muscle weakness was detected, and a workup for underlying malignancy was negative. We present this patient to bring further awareness to the observation that tissue eosinophilia in dermatomyositis may be associated with pruritus and more common than previously reported, supporting a paradigm shift in the diagnosis of collagen vascular disease.

Financial Disclosure:
No current or relevant financial relationships exist.

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Jack Reid, MD