The ultrasonographic manifestation of infected skeletal muscles in a patient with fulminant dermatomyositis with rhabdomyolysis

Dermatomyositis (DM) is a chronic, idiopathic inflammatory myopathy with characteristic cutaneous changes. The main symptoms include symmetric, proximal muscle weakness, especially shoulder or pelvic girdle muscles, with myalgia and skin rash. Glucocorticosteroids are usually the first-line empirical therapy in patients with DM. Immunosuppressive treatment including immunoglobulin and biological therapy is used in case of organ involvement and lack of treatment efficacy.

A case of a thirty-two year old patient with dermatomyositis and rhabdomyolysis (CPK 55 007 U/l) is presented in the article. Apart from typical skin rash, ultrastructural damage in skeletal muscles with myalgia and muscle weakness (especially neck muscles, shoulder and pelvic girdle muscles) was observed in this patient. The physical examination showed an enlarged neck circumference; the muscles were tough, hard, painful and tense. In the ultrasonographic picture of muscles the characteristic features of inflammatory myopathy were observed. Therapy with methylprednisolone was promptly administered. The improvement of general condition, return of muscular strength, decrease of biochemical parameters of inflammation, normalization of muscle enzymes and regression of USG-measured indicators of muscle damage was achieved (Table I and Fig. 1, 2).