10.5826/dpc.1302a111
text/xml
2160-9381
2817
en
Daniel Morgado-Carrasco
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Violaceous Macules on the Auricles: A Clinical Sign of Dermatomyositis
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-04-29
2022-09-05
2023-04-29
2023-06-05
e2023111
Dermatol Pract Concept
Daniel Morgado-Carrasco
2023/04/29
10.5826/dpc.1302a111
e2023111
Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
2160-9381
en
e2023111
Okiyama N, Inoue S, Saito A. et al. Antihelix/helix violaceous macules in Japanese patients with anti-melanoma differentiation-associated protein 5 (MDA5) antibody-associated dermatomyositis. Br J Dermatol. 2019;180(5):1226-1227. DOI: 10.1111/bjd.17431
Violaceous Macules on the Auricles: A Clinical Sign of Dermatomyositis
https://dpcj.org/index.php/dpc/article/download/2817/2103
 Violaceous Macules on the Auricles: a Clinical Sign
               of Dermatomyositis
              Lluís Corbella-Bagot1, Francesc Alamon-Reig1, Daniel Morgado-Carrasco1


1 Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain



Citation: Corbella-Bagot L, Alamon-Reig F, Morgado-Carrasco D. Violaceous Macules on the Auricles: A Clinical Sign of Dermatomyositis.
Dermatol Pract Concept. 2023;13(2):e2023111. DOI: https://doi.org/10.5826/dpc.1302a111
Accepted: October 26, 2022; Published: April 2023
Copyright: ©2023 Corbella-Bagot et al. This is an open-access article distributed under the terms of the Creative Commons
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Daniel Morgado-Carrasco, Dermatology Department, Hospital Clínic de Barcelona, C/ Villarroel, 170, 08036,
Barcelona, Spain. Tel: (+34) 93 227 54 00; Fax: (+34) 932275438 E-mail: morgadodaniel8@gmail.com




Case Presentation                                                        Teaching Point
A 66-year-old male with a recently diagnosed metastatic                  Dermatomyositis can present with a myriad of cutaneous
bladder carcinoma presented with muscle weakness and                     manifestations. Violaceous macules on the ears have recently
generalized pruritic rash. Physical examination revealed he-             been described in anti-melanoma differentiation-associated
liotrope erythema, V-neck sign, shawl sign, Gottron papules              gene 5 (MDA-5) dermatomyositis and may correlate with
and dilated nailfold capillary loops. Interestingly, several             a poor prognosis [1]. As the violaceous macules and ul-
purpuric macules, together with ulcers and crusting were ob-             cers are predominantly located in anatomic protuber-
served in both auricles (Figure 1). Blood tests showed high              ances in the auricle, a pressure-induced microangiopathy
muscle enzymes (creatine-kinase 5954 U/l [normal value                   has been proposed as the pathogenic mechanism [2]. We
<300 U/l] and aldolase 43.5 U/l [normal range 0.3-6.0 U/l]),             have not found any described case presenting with positive
and anti-transcriptional intermediary factor 1 gamma (TIF1-γ)            anti-TIF1-γ antibodies, which have been associated with
antibody positivity. The remaining myositis-specific antibodies          malignancies.
were negative. Skin and muscle biopsies confirmed the diag-                   We report a case of a paraneoplastic anti-TIF1-γ posi-
nosis of dermatomyositis. Treatment with prednisone 120 mg/              tive dermatomyositis presenting with violaceous macules in
day (1 mg/kg/day) and hydroxychloroquine 400 mg/day was                  both auricles. Clinicians should be aware of this recently
initiated with progressive improvement of muscle weakness                described clinical sign since it may be related to a poor
and cutaneous involvement. The patient also started chemo-               prognosis.
therapy with gemcitabine and cisplatin and is currently under                 A written consent form signed by the patient has been
follow-up in the Oncology and Dermatology departments.                   obtained.




Image Letter | Dermatol Pract Concept. 2023;13(2):e2023111                                                                          1
Figure 1. (A, B) Violaceous macules, crusting and ulcers on both auricles. The lesions are more evident in anatomical protuberances such
as the helix and antihelix.




References                                                             2. Okiyama N, Inoue S, Saito A. et al. Antihelix/helix viola-
                                                                          ceous macules in Japanese patients with anti-melanoma
1. Intapiboon P, Siripaitoon B. Erythematous auricular papules            differentiation-associated protein 5 (MDA5) antibody-associated
   in the fatal cases of anti-MDA5 antibody-positive interstitial         dermatomyositis. Br J Dermatol. 2019;180(5):1226-1227. DOI:
   lung disease. Respir Med Case Rep. 2020;19;31:101299. DOI:             10.1111/bjd.17431. PMID: 30431155.
   10.1016/j.rmcr.2020.101299. PMID: 33294359. PMCID:
   PMC7695884.




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