Inverse Gottron's Sign in A Patient With Anti-MDA5 Associated Dermatomyositis With Rapidly Progressive Interstitial Lung Disease

Abstract

A 61-year-old feamle presented with a 1-month history of painful skin lesions involving her digits. Physical examination demonstrated digital pulp ulcerations secondary to fingertip ischaemia. Erythematous and raised hyperkeratotic papules on the palms of both hands were noted as well (Figure A and B). Dorsal aspect of the hands and the rest of the skin were normal. There was no evidence of arthritis or muscle weakness. Auscultation of the lungs revealed bi-basal fine inspiratory crepitations. Two months ago, she presented with acute-on-chronic dyspnoea that was investigated for interstitial lung disease (ILD).