Dramatic heliotrope dermatitis and uncommon pulmonary involvement in juvenile dermatomyositis.

and interstitial lung disease is frequently identifi ed abnormality by CT. 3 Here we present a JDM case with severe heliotrope rash and uncommon manifestation in CT image of the lung. A 15-year-old girl presented with a 3-month history of progressive periorbital swelling and a reddishpurple rash on the upper and lower eyelids ( fi gure 1A ). Her vision acuity decreased and MRI showed only thickening of soft tissue in bilateral eyelids. Three weeks before admission, she started to present with middle grade fever, leukocytopenia, anorexia, polyarthralgia and mild symmetrical proximal muscle weakness. She had a skin rash in the V neck region and periungual vascular dilatation, but neither Gottron’s papules or the shoulder shawl cutaneous signs were identifi ed. Her lung fi elds were clear to auscultation. Laboratory fi ndings demonstrated that serum levels of muscle enzymes were mildly elevated. Antinuclear antibodies and anti–Jo–1 were negative. Electromyography demonstrated myopathic changes. Histologic fi ndings of quadriceps biopsy were compatible with JDM. CT of the chest showed multiple patchy opacities ( fi gure 1C ). The patient underwent CT-guided needle biopsy. Pathological analysis showed no signs of lung malignancy. Cultures for Images in...