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2018 ; 10
(5
): e2608
Nephropedia Template TP
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The Emergence of a Forgotten Entity: Dermatomyositis-like Presentation of Lyme
Disease in Rural Wisconsin
#MMPMID30013872
Novitch M
; Wahab A
; Kakarala R
; Mukerji R
Cureus
2018[May]; 10
(5
): e2608
PMID30013872
show ga
Dermatomyositis (DM) is one of the rare clinical manifestations of
tickborne-related autoimmune presentations; we report an uncommon case of
Borrelia-related DM-like presentation from rural Wisconsin. A 76-year-old female
presented with fatigue, malaise, weight loss and progressive proximal muscle
weakness after a flare-up of shoulder arthritis. She had a heliotrope rash and a
Shawl sign in addition to generalized cutaneous erythema with edema. There was no
history of tick bite, Lyme disease (LD) or DM. The physical exam revealed
erythema migrans (EM) and DM-like musculocutaneous findings. Enzyme-linked
immunosorbent assay and western blot were positive for LD. The patient received
intravenous ceftriaxone and doxycycline for five days, leading to the resolution
of EM lesions and improvement in her muscle weakness. In addition, DM-like
features resolved with antiborrelial treatment and required no steroids or
immunosuppressants. Workup including electromyography, skin or muscle biopsy
could not be performed as the patient improved clinically. At six months
post-treatment, she remained in remission.