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Erythroderma and extensive poikiloderma – a rare initial presentation of dermatomyositis: a case report

Overview of attention for article published in Journal of Medical Case Reports, March 2018
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Title
Erythroderma and extensive poikiloderma – a rare initial presentation of dermatomyositis: a case report
Published in
Journal of Medical Case Reports, March 2018
DOI 10.1186/s13256-018-1618-y
Pubmed ID
Authors

H. M. M. T. B. Herath, B. S. D. P. Keragala, S. P. Pahalagamage, G. H. C. C. Janappriya, Aruna Kulatunga, C. N. Gunasekera

Abstract

Dermatomyositis is a humoral-mediated inflammatory myopathy with symmetrical proximal muscle weakness and dermatological manifestations such as Gottron's papules, heliotrope rash, periungual abnormalities, and flagellate erythema. Erythroderma is a severe and potentially life-threatening dermatological condition with diffuse erythema and scaling involving more than 90% of the skin surface area. Poikiloderma vasculare atrophicans refers to mottled hyperpigmentation and hypopigmentation of the skin with in-between telangiectases and areas of atrophy and is considered a variant of mycosis fungoides. Poikilodermatomyositis is the term given to the condition with poikiloderma and inflammatory myopathy. Only a few cases are reported on erythroderma in dermatomyositis and poikilodermatomyositis. Erythrodermal pattern of dermatomyositis transforming into poikilodermatomyositis is a recognized rare manifestation of dermatomyositis and we could find only one case report in the literature. A 53-year-old Sri Lankan woman presented with intermittent fever of 5 months' duration with erythroderma. Later she developed progressive, symmetrical proximal muscle weakness. Following a short course of small dose steroids, erythroderma settled but changed to extensive poikiloderma involving more than 90% of her skin with her face being relatively spared. She had an early heliotrope rash, shawl sign, and Gottron papules. Electromyography and muscle biopsy were supportive of inflammatory myositis and skin biopsy showed evidence of dermatomyositis. Inflammatory markers and muscle enzymes were also elevated. Autoimmune antibodies and myositis-specific autoantibodies were negative. She was started on orally administered prednisolone 1 mg/kg per day with methotrexate 10 mg once a week and had a good response to treatment with resolution of the skin condition and improvement of muscle power. Imaging studies, endoscopies, and tumor markers did not reveal any malignancy. This case illustrates a rare presentation of dermatomyositis initially presenting as fever, erythroderma, and proximal muscle weakness and later developing poikiloderma involving more than 90% of the skin. It is important to be aware of this rare presentation to avoid misdiagnosis. With the currently available literature it is not possible to conclude that erythroderma is a bad prognostic factor in dermatomyositis or a predictive factor for a malignancy. Patients have a good response to steroids with a combination of immunosuppressants.

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 25 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 25 100%

Demographic breakdown

Readers by professional status Count As %
Student > Bachelor 4 16%
Other 2 8%
Student > Master 2 8%
Student > Postgraduate 2 8%
Student > Doctoral Student 1 4%
Other 4 16%
Unknown 10 40%
Readers by discipline Count As %
Medicine and Dentistry 9 36%
Pharmacology, Toxicology and Pharmaceutical Science 1 4%
Nursing and Health Professions 1 4%
Biochemistry, Genetics and Molecular Biology 1 4%
Computer Science 1 4%
Other 1 4%
Unknown 11 44%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 08 April 2018.
All research outputs
#17,934,709
of 23,028,364 outputs
Outputs from Journal of Medical Case Reports
#1,927
of 3,948 outputs
Outputs of similar age
#240,774
of 331,324 outputs
Outputs of similar age from Journal of Medical Case Reports
#43
of 82 outputs
Altmetric has tracked 23,028,364 research outputs across all sources so far. This one is in the 19th percentile – i.e., 19% of other outputs scored the same or lower than it.
So far Altmetric has tracked 3,948 research outputs from this source. They receive a mean Attention Score of 4.0. This one is in the 42nd percentile – i.e., 42% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 331,324 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 22nd percentile – i.e., 22% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 82 others from the same source and published within six weeks on either side of this one. This one is in the 41st percentile – i.e., 41% of its contemporaries scored the same or lower than it.