Anti-MDA5-Positive Dermatomyositis Presenting as Fever of Unknown Origin.

J Gen Intern Med 2016 12;31(12):1530-1536

Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.

Dermatomyositis is a chronic systemic autoimmune disease characterized by inflammatory infiltrates in the skin and muscle. The wide variability in clinical and serologic presentation poses a diagnostic challenge for the internist. Appreciation of the clinical variants of dermatomyositis allows for expedient diagnosis and avoidance of diagnostic error. We illustrate these challenges with the case of a 51-year-old Vietnamese-American man who initially presented with fever of unknown origin in the absence of overt skin and muscle manifestations. The diagnosis of dermatomyositis was not evident on several clinical encounters due to the absence of these hallmark symptoms. We review the variable clinical manifestations of a subtype of dermatomyositis associated with an autoantibody against melanoma differentiation-associated protein 5 (anti-MDA5) and suggest consideration of dermatomyositis as a diagnosis in patients presenting with systemic illness and markedly elevated ferritin, even in the absence of elevated muscle enzymes and classic autoantibodies.

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11606-016-3769-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5130943PMC
December 2016

Publication Analysis

Top Keywords

unknown origin
8
skin muscle
8
fever unknown
8
dermatomyositis
5
consideration dermatomyositis
4
challenges case
4
dermatomyositis diagnosis
4
illustrate challenges
4
man initially
4
case 51-year-old
4
vietnamese-american man
4
51-year-old vietnamese-american
4
anti-mda5 consideration
4
error illustrate
4
protein anti-mda5
4
diagnostic error
4
allows expedient
4
dermatomyositis allows
4
dermatomyositis associated
4
variants dermatomyositis
4

Similar Publications