A 21-year-old woman developed edematous erythemas on her face, fingers, upper arms, knees and thighs, some of those lesions were ulcerated. Histopathological findings from the erythema on her thigh showed degenerated keratinocytes, dermal edema. and inflammatory infiltrations of lymphocytes and histiocytes around vessels and hair follicles. Laboratory blood examinations revealed pancytopenia, liver dysfunction and elevations of ferritin, CEA, CA19-9, KL-6 and aldolase, but not of CK. Antinuclear, anti-DNA, anti-Jo-1, andantiU1RNP antibodies were negative, but an antibody against 140 kDa protein (anti-CADM-140 antibody, antiMDA5 antibody) was detected in her serum by immunoprecipitation. A manual muscle test showed a slight proximal muscle weakness. In addition, an electromyogram and muscle MRI showed mild muscle inflammation. No interstitial pneumonia or malignancy was detected. Her clinical symptoms and all her hematological abnormalities spontaneously regressed within 8 months. The presence of pancytopenia and the other abnormal laboratory data may have indicated a preceding viral or other infection. We speculate that such an infection may have been associated with the transient dermatomyositis-like symptoms of this patient because she had an anti-MDA5 antibody, which is strongly associated with amyopathic dermatomyositis with rapidly progressive interstitial pneumonia.
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