There are very few reported incidences of juvenile dermatomyositis in the Philippine setting.
This is a case of a 9-year-old female from Batangas City, who came in with a 3-year history of multiple non-tender, non-pruritic erythematous papules which started on the dorsal aspect of the metacarpophalangeal (MCP) and interphalangeal joints of the hands, with some progressing into plaques on the face and extremities. No other associated symptoms such as fever, cough, colds or weakness were noted. Three months prior to consult, there was persistence of the above-mentioned lesions with body weakness described as difficulty getting out of bed and climbing stairs. Consult with a dermatologist and rheumatologist was done. A skin punch biopsy showed hyperkeratosis of the stratum corneum. There was focal vacuolar alteration of the basal cell layer with thickening of the basement membrane zone. The papillary dermis showed pigment-laden macrophages, a calcified nodule, fibrosis, and a sparse perivascular inflammatory infiltrate of lymphocytes. There was also thickening of the basement membrane zone on Periodic acid-Schiff stain. Both clinical and histopathological findings point to Juvenile Dermatomyositis.
Juvenile Dermatomyositis requires prompt diagnosis for proper treatment and prognostication. This entails extensive diagnostic procedures such as skin punch biopsy, muscle enzymes such as CK-MB and CK- MM, and blood tests. Co-management with a pediatric rheumatologist is highly advised for initiation and regulation of oral corticosteroids as well as vitamin supplementation.