Rheumatology International

, Volume 40, Issue 2, pp 331–336 | Cite as

Dilemma in management of hemorrhagic myositis in dermatomyositis

  • Julia M. ChandlerEmail author
  • Yoo Jung Kim
  • Justin L. Bauer
  • Irene L. Wapnir
Case Based Review


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.


Dermatomyositis complications Myositis Hemorrhage Hematoma 



The authors would like to thank Dr. Matthew Lewis for his review of the manuscript.

Author contributions

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

Informed consent was obtained from the patient described in the study, including permission for release of photographs.


  1. 1.
    Bernatsky S, Joseph L, Pineau CA, Belisle P, Boivin JF, Banerjee D, Clarke AE (2009) Estimating the prevalence of polymyositis and dermatomyositis from administrative data: age, sex and regional differences. Ann Rheum Dis 68(7):1192–1196. CrossRefPubMedGoogle Scholar
  2. 2.
    Bendewald MJ, Wetter DA, Li X, Davis MD (2010) Incidence of dermatomyositis and clinically amyopathic dermatomyositis: a population-based study in Olmsted County Minnesota. Arch Dermatol 146(1):26–30. CrossRefPubMedGoogle Scholar
  3. 3.
    Krathen MS, Fiorentino D, Werth VP (2008) Dermatomyositis. Curr Dir Autoimmun 10:313–332. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Yamagishi M, Tajima S, Suetake A, Kawakami H, Watanabe T, Kuriyama H, Takada T, Suzuki E, Gejyo F (2009) Dermatomyositis with hemorrhagic myositis. Rheumatol Int 29(11):1363–1366. CrossRefPubMedGoogle Scholar
  5. 5.
    Higashi Y, Mera K, Kanzaki T, Kanekura T (2009) Fatal muscle haemorrhage attributable to heparin administration in a patient with dermatomyositis. Clin Exp Dermatol 34(3):448–449. CrossRefPubMedGoogle Scholar
  6. 6.
    Hanawa F, Inozume T, Harada K, Andou N, Kawamura T, Shibagaki N, Shimada S (2013) A case of dermatomyositis accompanied by spontaneous intramuscular hemorrhage despite normal coagulability. Rheumatol Int 33(11):2949–2950. CrossRefPubMedGoogle Scholar
  7. 7.
    Van Gelder H, Wu KM, Gharibian N, Patel DB, Clements PJ, Heinze ER, Morris RI, Wong AL (2014) Acute hemorrhagic myositis in inflammatory myopathy and review of the literature. Case Rep Rheumatol 2014:639756. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Chen YH, Wu PC, Ko PY, Lin YN (2015) Retroperitoneal hematoma mimicking exacerbation of dermatomyositis. Intern Med 54(8):995–996. CrossRefPubMedGoogle Scholar
  9. 9.
    Langguth DM, Wong RC, Archibald C, Hogan PG (2004) Haemorrhagic myositis associated with prophylactic heparin use in dermatomyositis. Ann Rheum Dis 63(4):464–465. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Orrell RW, Johnston HM, Gibson C, Cass RM, Griggs RC (1998) Spontaneous abdominal hematoma in dermatomyositis. Muscle Nerve 21(12):1800–1803.;2-z CrossRefPubMedGoogle Scholar
  11. 11.
    Miwa Y, Muramatsu M, Takahashi R, Wakabayashi K, Odai T, Isozaki T, Yajima N, Kasama T (2010) Dermatomyositis complicated with hemorrhagic shock of the iliopsoas muscle on both sides and the thigh muscle. Mod Rheumatol 20(4):420–422. CrossRefPubMedGoogle Scholar
  12. 12.
    Touma L, Cohen S, Cassinotto C, Reinhold C, Barkun A, Tran VT, Banon O, Valenti D, Gallix B, Dohan A (2019) Transcatheter arterial embolization of spontaneous soft tissue hematomas: a systematic review. Cardiovasc Interv Radiol 42(3):335–343. CrossRefGoogle Scholar
  13. 13.
    Karapolat B, Tasdelen HA, Korkmaz HAA (2019) Conservative treatment of spontaneous rectus sheath hematomas: single center experience and literature review. Emerg Med Int 2019:2406873. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Dohan A, Darnige L, Sapoval M, Pellerin O (2015) Spontaneous soft tissue hematomas. Diagn Interv Imaging 96(7–8):789–796. CrossRefPubMedGoogle Scholar
  15. 15.
    Li Y, Wang P, Li L, Wang F, Liu Y (2018) Increased risk of venous thromboembolism associated with polymyositis and dermatomyositis: a meta-analysis. Ther Clin Risk Manag 14:157–165. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Wagner DD, Burger PC (2003) Platelets in inflammation and thrombosis. Arterioscler Thromb Vasc Biol 23(12):2131–2137. CrossRefPubMedGoogle Scholar
  17. 17.
    Kohsaka H, Mimori T, Kanda T, Shimizu J, Sunada Y, Fujimoto M, Kawaguchi Y, Jinnin M, Muro Y, Ishihara S, Tomimitsu H, Ohta A, Sumida T (2019) Treatment consensus for management of polymyositis and dermatomyositis among rheumatologists, neurologists and dermatologists. Mod Rheumatol 29(1):1–19. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryStanford University School of MedicineStanfordUSA
  2. 2.Stanford University School of MedicineStanfordUSA
  3. 3.Department of RadiologyStanford University School of MedicineStanfordUSA

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