Abstract
In this case, we describe an unusual presentation of a young woman with a rash typical of morphoea (confirmed on biopsy), who went on to develop myositis in an atypical distribution. Although the association of myositis with diffuse systemic sclerosis is well described, the link with localised scleroderma (morphoea) and myositis has not been described.
Highlights
A 33 year old previously fit and well Caucasian woman presented to the Dermatology clinic with a tender atrophic eruption involving the flexures of both arms, dorsum of hands, chest and back associated with nail changes
As a connective tissue disorder was suspected, she underwent nailfold capillaroscopy which revealed a grossly abnormal pattern of capillary network consistent with an autoimmune connective tissue disease. She was diagnosed with Atrophoderma of Pasini and Pierini, a form of dermal atrophy of unknown aetiology which can be associated with the spirochete Borrelia burgdorferi, and is transmitted by tick bites
Borrelia burgdorferi serology was negative and there was no recollection of any tick bites, she received a course of oral Doxycyline
Summary
A 33 year old previously fit and well Caucasian woman presented to the Dermatology clinic with a tender atrophic eruption involving the flexures of both arms, dorsum of hands, chest and back (see Figure 1) associated with nail changes. She was diagnosed with Atrophoderma of Pasini and Pierini, a form of dermal atrophy of unknown aetiology which can be associated with the spirochete Borrelia burgdorferi, and is transmitted by tick bites. Half of patients with Atrophoderma of Pasini and Pierini having positive B. burgdorferi serology [1]. She did not have any other symptoms consistent with systemic sclerosis or any other connective tissue disease.
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