CASE OF UNUSUAL RASH

     I saw her as one of the new patient on one Tuesday. She was referred to me by an allergist. Patient was 37 years old white female , who had cough far 3-4 months. So her primary care physician referred to the allergist. The allergist did the allergy tests , did chest x-ray, and even tried treatment for the 'acid reflux' . The allergy tests were negative, and still she was tried on nasal steroid, and other allergy medicines. Nothing worked. When I asked on the x-ray report, she said 'it showed pneumonia ' and so she was treated with antibiotics. No repeat x-ray was done. I was surprised as to why was she referred to an allergist and not to 'lung specialist ', like me .
    When I examined her I noticed a faint rash on her arms . I asked her about it . Then she said " now I remember why I went to the allergist. I have this rash, and the over the counter pills for the allergy , like claratin and Zyrtec did not work. so  I was referred to her. ". I asked her about the any shortness of the breath. She said " I have been always short of breath, I thought it was due to my weight. " She was quite obese, but when I asked her , she was little more short of breath than before. This could have been due to 'deconditioning ', as her activity level was quite low . Her examination otherwise  unremarkable . When I got hold of the old x-ray, it did show some 'congestion ' i.e. infiltrates , in lower lower part of the lungs . I did cat scan and the breathing test . The ct scan showed same findings, the infiltrates, and the breathing test did show reduced lung capacity, especially, the DLco, the diffusion capacity. ( how the oxygen goes across the lungs ). was lower . I decided to do the bronchoscopy and biopsy. (looking inside the lungs and biopsy. )  I also ordered some blood tests . I felt that she was 'weak' and was not sure what I was the diagnosis , but due to rash , her shortness of the breath, and the lung infiltrate and her weakness, was worried about some sort of connective tissue disorder.
   The biopsy showed some 'inflamation' and the blood tests were positive. They gave the diagnosis. She had quite elevated muscle enzymes and other tests were diagnostic for what is called 'Dermatomyositis '.

   In this disease patients have rash, have some muscular weakness, and other abnormalities . The treatment is steroids . She was put on it and referred to rheumatologist and did very well, except that she never lost any weight .