Poikiloderma as a Presenting Sign of Amyopathic Dermatomyositis

PresentationA 71-year-old female presented to primary care with 4 months of a pruritic, erythematous rash on the right side of her face (Figure 1).She had no other symptoms with review of systems negative for myalgias, arthralgias, malar rash, photosensitivity, weakness, numbness, or tingling.Initial exam revealed a mottled, erythematous, blanching plaque on the right side of the face and normal strength throughout.Over a year the rash progressed to involve the left side of her face, eyelids, dorsal surface of the hands with violaceous papules over the extensor surfaces of the metacarpophalangeal and interphalangeal joints, forehead, upper arms, and thighs.Laboratory testing showed normal AST, ALT, CK, aldolase, SSB, anti-histone Ab, Mi-2 Auto Ab.ANA was positive with a titer of >1:2560 with a speckled staining pattern.SSA and antismall ubiquitin-like modifier activating enzyme (SAE) autoantibodies were also positive.