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Clinical Review Interactive case report

A 66 year old woman with a rash: case progression

BMJ 2003; 326 doi: (Published 22 March 2003) Cite this as: BMJ 2003;326:640
  1. J Bligh, professor (,
  2. R Farrow, director of problem based learning
  1. Peninsula Medical School, Tamar Science Park, Plymouth PL6 8BX
  1. Correspondence to: J Bligh

    Last week (p 588) we presented the case of Ruth, a 66 year old housewife who presented to her general practitioner with a two to three month history of feeling “out of sorts” and an erythematous papular 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 at the rapid responses and discussion of the case so far go to (

    Ruth was referred to a consultant dermatologist, who agreed that the most likely diagnosis was dermatomyositis. A skin biopsy showed a sparse lymphocytic inflammatory infiltrate and mild upper dermal oedema. Immunofluorescence gave non-contributory and non-specific results: IgG and C3 tested negative, IgA showed …

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