Juvenile dermatomyositis with tongue calcinosis and poor growth.

摘要

A 9-year-old boy presented with an 18-month history of faltering growth, recurrent respiratory tract infections, persistent 'apthous' ulcer on his tongue and 'warts' on his fingertips and soles. He is the second offspring of a healthy unrelated Sri Lankan couple and past medical history was unremarkable. Baseline immunology and infectious disease screen were negative. On close questioning the patient had reduced energy levels, poor appetite and dysphagia of solids. His growth parameters were below the fifth centile, he had sustained central muscle weakness, a heliotrope rash on his eyelids and extruding calcinosis on his palms and soles, nail beds and tongue (figures 1 and 2). He was clinically diagnosed with juvenile dermatomyositis (JDM) and underwent investigations to define disease severity. Muscle biopsy confirmed the diagnosis.