Dilemma in management of hemorrhagic myositis in dermatomyositis
Dermatomyositis (DM) is a rare inflammatory disorder affecting the muscle and skin. DM patients can present with spontaneous muscle hemorrhage, a potentially fatal complication. The best practice for management of hemorrhagic myositis in these patients remains unclear. Here we discuss the case of a patient who presented with progressive muscle weakness and intermittent rash that was diagnosed with dermatomyositis. During admission, she developed spontaneous hemorrhagic myositis of the right pectoralis major treated with surgical evacuation. She also developed a spontaneous left anterior thigh hematoma which was treated conservatively. She recovered and showed no evidence of recurrent bleeding at either location. We performed a literature review and identified ten cases of spontaneous hemorrhage in DM patients, with a 60% mortality rate among reported cases. Given the high mortality rate associated with spontaneous hemorrhage in DM patients, it is important for physicians to be aware of the diagnosis, workup, and management strategies.
KeywordsDermatomyositis complications Myositis Hemorrhage Hematoma
The authors would like to thank Dr. Matthew Lewis for his review of the manuscript.
JC conceived the study and drafted and critically revised the manuscript. YK performed the literature search and drafted and critically revised the manuscript. JB critically revised the manuscript and provided guidance on radiologic findings. IW critically revised the manuscript and provided overall guidance for the project. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work.
There was no funding provided for this report.
Compliance with ethical standards
Conflict of interest
The authors report no conflicts of interest.
Informed consent was obtained from the patient described in the study, including permission for release of photographs.
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