Carbimazole-induced juvenile dermatomyositis

Abstract

E‐mail: stephflocohenbacrie@free.fr Conflicts of interest: none declared. Sir, Juvenile dermatomyositis (JD) is an inflammatory multisystem disease affecting skin and muscle, causing symmetric proximal weakness and characteristic skin rash. Drug‐related dermatomyositis has been reported rarely in adults but not in children.1, 2 This is the first report of JD induced by carbimazole. A 10‐year‐old girl was referred to the dermatology department at CHU Rangueil for an 11‐month history of skin lesions, asthenia and arthralgia. Past medical history included a diagnosis of Graves’ disease. She was treated with carbimazole and hyperthyroidism regressed after approximately 5 months. Three months after starting carbimazole, the patient developed arthralgia and asthenia. Three months later, skin lesions were noted. Five months later, she was referred to our department. Skin examination revealed symmetric erythematous and slightly scaly plaques on knees, elbows and medial malleolus. There were firm subcutaneous nodules on the extension aspect of both arms. She also had an eyelid erythema (Fig. 1a) and erythematous papules on the dorsal aspect of finger joints (Fig. 1b). She had symmetrical inflammatory pain of large and small joints, and weakness of the muscles without muscle pain. Rheumatological examination revealed stiffness of the knees and left elbow associated with flessum. Her fingers were swollen with a spindle aspect (Fig. 1b). Muscle strength testing showed a symmetric proximal weakness. She had high creatine kinase level of 230 U L−1 (0–140) and high aldolase level of 16 U L−1 (0–10). The antinuclear antibody titre was 1/320, without anti‐DNA antibody or antiextractable nuclear antigens. Complement, thyroid stimulating hormone and T4 were within normal range.