Interactive case report: A 66 year old woman with a rash: case progression

doi:10.1136/bmj.326.7390.640

BMJ 2003;326:640 ( 22 March )

Clinical review

Interactive case report

A 66 year old woman with a rash: case progression

J Bligh, professor, R Farrow, director of problem based learning.

Peninsula Medical School, Tamar Science Park, Plymouth PL6 8BX

Correspondence to: J Bligh j.bligh@pms.ac.uk
The first 150 words of the full text of this article appear below.

Last week (p 588) we presented the case of Ruth, a 66 year old housewife who presented to her general practitioner with atwo to three month history of feeling "out of sorts" and an erythematouspapular rash affecting the fingers, dorsum of the hands, knees,elbows, and neck. We invited responses on the likely diagnosis,further investigation, and what to tell the patient. To look atthe rapid responses and discussion of the case so far go to bmj.com(http://bmj.com/cgi/content/full/326/7389/588).

Ruth was referred to a consultant dermatologist, who agreed that the most likely diagnosis was dermatomyositis. A skin biopsyshowed a sparse lymphocytic inflammatory infiltrate and mild upperdermal oedema. Immunofluorescence gave non-contributory and non-specificresults: IgG and C3 tested negative, IgA showed spotty coarseintraepidermal positivity, and there was mild IgM positivity inthe basement membrane.

Table Removed (Available Only in the Full Text)

Because of the known association between dermatomyositis and malignant disease . . . [Full text of this article]

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Rapid Responses:

Read all Rapid Responses

Surgery: DR.G..CHIDAMBARAN Ganapathy
bmj.com, 22 Mar 2003 [Full text]
Problems with Ruth: Dr.Nabeela Nisar
bmj.com, 22 Mar 2003 [Full text]
Splenic Aneurysm:treatment indicated but not open surgery!: Tony Nicholson
bmj.com, 23 Mar 2003 [Full text]
Urgent surgical intervention is imperative: Richard G Fiddian-Green
bmj.com, 23 Mar 2003 [Full text]
Splenic artery aneurysms: Sujoy Khan
bmj.com, 24 Mar 2003 [Full text]
Pity poor Ruth: Mark Powlson
bmj.com, 24 Mar 2003 [Full text]
Early intervention is required.: Peter R Taylor, et al.
bmj.com, 24 Mar 2003 [Full text]
Re: Problems with Ruth: Waqar A Khan
bmj.com, 24 Mar 2003 [Full text]
Heisenberg's principle of worst mistakes: Richard G Fiddian-Green
bmj.com, 24 Mar 2003 [Full text]
Response from vascular commentator: Linda J. Hands
bmj.com, 24 Mar 2003 [Full text]
Primary care perspective: Wilfrid Treasure
bmj.com, 25 Mar 2003 [Full text]
gastroprotection ?: Alessandro Calderan
bmj.com, 25 Mar 2003 [Full text]
Don't waste any more time fiddling: Richard G Fiddian-Green
bmj.com, 25 Mar 2003 [Full text]
Ruth's Response: Richard Farrow
bmj.com, 25 Mar 2003 [Full text]
Poor choice of investigations?: Brian N Stein
bmj.com, 25 Mar 2003 [Full text]
Ruth's steroids are going to be a problem...: Andrew N Bamji
bmj.com, 27 Mar 2003 [Full text]
Angiogram or MRI: Richard G Fiddian-Green
bmj.com, 28 Mar 2003 [Full text]
Other possibilty: Bernard SF Stacey
bmj.com, 16 Aug 2003 [Full text]