Acute oedematous dermatomyositis

There are many published reports of limb oedema occurring in various rheumatic diseases.1 It may be present in patients with dermatomyositis oedema, especially where the subcutaneous tissue is loose, such as the upper eyelids.2 A 27 year old woman presented with an eight week history of a progressive increase in girth of both forearms and tightening of the overlying skin. Four weeks from onset she had developed a triad of cutaneous features: a periorbital heliotrope rash, an erythematous malar rash affecting the nasolabial folds, and a ‘V’ sign rash on her neck. Two weeks later proximal muscle weakness developed. Physical examination showed markedly oedematous forearms, the overlying skin was tense, and elbow extension limited. Nailfold capillary microscopy was abnormal showing disorganisation and dilatation. Neurological assessment showed grade 4 muscle power in hip flexors and shoulder abductors; other systems were normal. Investigations included a normal …