ACR Image Competition 2023 Results, Part 5

For the 2023 Image Competition, the ACR sought images representing a diverse range of patients with idiopathic inflammatory myopathies (IIMs) or IIM mimics.

Pneumomediastinum & Ulcerative Cutaneous Dermatomyositis

These images depict a 22-year-old woman with a recent diagnosis of anti-melanoma differentiation-associated gene 5 (MDA-5) antibody dermatomyositis who sought evaluation of worsening skin rashes and pleuritic chest pain. On examination, the patient was found to have heliotrope rash of the eyelids, digital pulp, third metacarpophalangeal joint ulcerations and Gottron’s sign of the elbows. A computed tomography (CT) chest scan showed moderately sized pneumomediastinum (blue arrows) dissecting into deep neck spaces and multifocal peripheral reticular opacities (red arrows) consistent with early interstitial lung disease (ILD).

Anti-MDA-5 antibody dermatomyositis represents an aggressive subset of myositis that can involve ulcerative cutaneous disease, rapidly progressive ILD, and rarely, spontaneous pneumomediastinum.

Learn More

Because anti-MDA-5 antibody dermatomyositis is a heterogeneous disease with many possible manifestations, it is important to evaluate specific lab parameters, such as white blood cell count, lymphocyte count, C-reactive protein and ferritin, to fully assess the patient and help identify disease subtypes. For more information, visit https://tinyurl.com/2wzwb4wn and review the section on IIMs.

David Mecham, DO, is an internist who specializes in rheumatology. He is affiliated with Doctors Hospital

of Augusta, Ga.