LB1605 3D imaging of cleared ex vivo normal human skin, skin appendages and psoriasiform skin lesion using light-sheet microscopy

Abstract

Dermatomyositis-related panniculitis (DP) manifests as red subcutaneous, firm and tender plaques, usually on the arms, buttocks, thighs and abdomen. DP is commonly described in textbooks yet there are few reports in the medical literature and there are no guidelines on its best management. Here we present a case of a patient with DP of the neck region. Case Description: A 66-year-old African American woman with a three-year history of dermatomyositis with high titer antinuclear antibody, characteristic pattern of rash, and muscle weakness presented with progressive neck swelling, neck pain, dysphagia, and dyspnea over a period of two months. Physical examination revealed extensive woody induration of the anterior neck region, mild tenderness on palpation on the right side, and decreased range of motion of the neck. CT scan demonstrated extensive soft tissue infiltration in the neck and mediastinum, pleural thickening, as well as a new 1.5 centimeter right lower lobe pulmonary nodule with irregular borders not previously seen on CT scan three months prior. PET scan demonstrated inflammation throughout the mediastinum and into the chest, but no area demonstrated significant avidity consistent with cancer. Flow cytometry was also negative. Histological examination of a neck biopsy demonstrated lobular panniculitis. Based on the histological appearance, a diagnosis of DP was made. Treatment with corticosteroids, dapsone, and colchicine resolved the DP and controlled the dermatomyositis symptoms. Repeat CT scan showed largely complete resolution of the pleural thickening, pulmonary nodule, and mediastinal mass. Conclusion: While cutaneous involvement of dermatomyositis is well described, subcutaneous involvement is a rarely reported clinical finding. This is the first report describing DP in the neck and mediastinal region. The parallel response to corticosteroids in the panniculitis and myositis suggest these processes share a related pathogenesis.