Sanchez Isabella I, Herrera Henry O, Elsensohn Ashley, Lee Bonnie A, Kraus Christina N
School of Medicine, University of California Irvine, Irvine, CA 92697, USA.
School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA.
Dermatopathology (Basel). 2023 Nov 21;10(4):310-317. doi: 10.3390/dermatopathology10040039.
Dermatomyositis is an idiopathic inflammatory myopathy that often presents with symmetric proximal skeletal muscle weakness and characteristic skin findings. Typical skin biopsy findings include vacuolar changes of the basal layer, increased dermal mucin, and a predominantly lymphocytic infiltrate. We report a case of dermatomyositis presenting as intensely pruritic papules and plaques, with initial histopathology being atypical of dermatomyositis due to the presence of eosinophils. The initial biopsy demonstrated a superficial dermatitis with eosinophils, initially thought to represent a drug eruption. A second biopsy of the same cutaneous manifestation was performed at a later time given high clinical suspicion for dermatomyositis and demonstrated a more classic vacuolar interface dermatitis with increased mucin and an absence of eosinophils. Notably, increased pruritus was specifically associated with the lesion that demonstrated tissue eosinophilia. The case illustrates the importance of considering tissue eosinophilia in the histologic presentation of dermatomyositis.
皮肌炎是一种特发性炎性肌病，常表现为对称性近端骨骼肌无力和特征性皮肤表现。典型的皮肤活检结果包括基底层空泡改变、真皮粘蛋白增加以及主要为淋巴细胞浸润。我们报告一例皮肌炎，表现为剧烈瘙痒的丘疹和斑块，由于存在嗜酸性粒细胞，初始组织病理学表现不典型。初始活检显示为伴有嗜酸性粒细胞的浅表性皮炎，最初认为是药物疹。鉴于高度怀疑皮肌炎，随后对同一皮肤表现进行了第二次活检，结果显示为更典型的空泡界面性皮炎，伴有粘蛋白增加且无嗜酸性粒细胞。值得注意的是，瘙痒加剧与显示组织嗜酸性粒细胞增多的病变密切相关。该病例说明了在皮肌炎的组织学表现中考虑组织嗜酸性粒细胞增多的重要性。
