Breast calcinosis, panniculitis and fat hypertrophy in a 35-year-old woman with dermatomyositis

Extract

Sir, We report the case of a 35-yr-old woman with a 12-yr history of dermatomyositis. She originally presented with proximal muscle weakness, fatigue, a heliotrope rash and Gottron's papules. Investigations confirmed a raised creatine kinase and typical histological changes on needle muscle biopsy. After a reducing dose of steroids, she was maintained on azathioprine 150 mg per day, switched due to lack of efficacy to weekly oral methotrexate 3 yrs later. Four years later she developed conspicuous weakness and wasting of the left upper arm, with clinical evidence of muscle atrophy affecting the left triceps. Hydroxychloroquine was later introduced due to active skin disease (typical facial rash, Gottron's papules and florid nail fold capillary changes) and subsequently cyclosporin, with good benefit, at a present dose of 75 mg bd.

For the last 2 yrs she has had an insidious and eventually marked asymmetry of her two arms, thought to be due to further wasting of her left triceps (Fig. 1). However, subsequent MRI imaging (Fig. 2) showed marked fat hypertrophy of her dominant right arm with no significant muscle atrophy. Biopsy of this was not performed.