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Dermatomyositis: A Rare Presentation of HIV Seroconversion Illness

Rajadhyaksha, Anjali MD; Baheti, Trupti G. MD; Mehra, Sonal MD; Sonawale, A. S. MD; Jain, N. MD

JCR: Journal of Clinical Rheumatology: September 2012 - Volume 18 - Issue 6 - p 298–300
doi: 10.1097/RHU.0b013e318268566c
Case Reports

Abstract: Dermatomyositis is a rare autoimmune inflammatory myopathy with proximal muscle weakness and skin affection. Only 4 cases of HIV that subsequently developed dermatomyositis have been reported. This is the first case of dermatomyositis being the initial presentation of an acute seroconversion illness. We highlight the pathophysiology of dermatomyositis in HIV infection along with the complex issues of treatment in such cases. We report a case of a 50-year-old woman who presented with a 2 months’ history of proximal muscle weakness with classic signs of dermatomyositis and consistent electromyographic and muscle biopsy. HIV (by enzyme-linked immunosorbent assay) was initially nonreactive, indeterminate at 4 weeks, and positive at 8 weeks. It was further confirmed by Western blot and polymerase chain reaction. She was treated with prednisolone and antiretroviral therapy. A high degree of suspicion is required to diagnose HIV seroconversion when an individual presents with dermatomyositis. A fine balance of immunosuppressants and antiretroviral therapy needs to be maintained in the treatment of such cases.

From the Department of Medicine and Rheumatology, KEM Hospital and Seth GS Medical College, Mumbai, India.

There is no funding from any organization to be disclosed.

The authors declare no conflict of interest.

Correspondence: Sonal Mehra, MD, 26, Rashi Apts, Plot 3, Sec 7, Dwarka, New Delhi, India 110075. E-mail: drsonalmehra@gmail.com.

© 2012 Lippincott Williams & Wilkins, Inc.