Dermatomyositis is a rare clinical entity characterized by symmetric proximal muscle weakness and distinctive skin rash. Though most cases are felt to be primary or idiopathic, the disease may present as a paraneoplastic syndrome or more commonly, in association with another connective tissue disorder. Treatment usually consists of high dose daily oral corticosteroids.

We report the case of 39 year old woman who presented with six month history of progressive rash, upper limb weakness and weight loss. A diagnosis of dematomyositis was confirmed on muscle biopsy. The patient was referred to our clinic to rule out an underlying gastrointestinal malignancy. Clinical course was complicated by severe hypocalcemia with carpopedal spasm post oral fleet phosphosoda preparation for colonoscopy. Subsequent laboratory testing revealed iron and folate deficiency, as well as other biochemical indices of malabsorption. Work-up further demonstrated secondary hyperparathyroidism and osteopenia due to longstanding calcium deficiency. Finally, small bowel biopsy revealed subtotal villous atrophy and moderate chronic inflammation consistent with celiac disease.

The patient was placed on a gluten-free diet. She received no specific therapy for dermatomyositis other than two doses of pulse methylprednisolone one week prior to her presentation with tetany. With strict dietary adherence, she showed remarkable improvement with 25 lb weight gain, restoration of full power and complete resolution of skin rash within 6-9 months. In addition, laboratory findings normalized and serial magnetic resonance spectroscopy demonstrated reversal of all muscle abnormalities.

To our knowledge, this is the first reported case of concomitant dermatomyositis and adult celiac disease. Both diseases remitted completely in response to gluten withdrawal alone. We believe that a diagnosis of celiac disease should be strongly considered in any adult patient with dermatomyositis even in the absence of overt gastrointestinal symptoms.

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