(BMJ)—A 9-yo boy presented w/ hx of poor growth, dysphagia, recurrent RTIs, a persistent “aphthous” ulcer on his tongue, and “warts” on his fingertips and soles. FHx: unremarkable. Exam: central muscle weakness, heliotrope rash on eyelids, calcinosis on palms, soles, nail beds, and tongue. What is the dx?
Werner syndrome
Scleroderma
Calciphylaxis
Juvenile dermatomyositis
Vitamin D toxicity
You are correct. He was clinically diagnosed w/ juvenile dermatomyositis (JDM). Muscle bx confirmed the dx. JDM is a rare autoimmune dz in childhood. Calcinosis is seen in 14% of children at presentation, while 30% of pts will develop it over the course of their dz. Presence of calcinosis has been linked w/ delayed dx or inadequate tx. This pt was treated w/ steroids and MTX and w/ surgical excision of the calcinosis on his tongue.

Arch Dis Child 2010;95:997