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A 16-year-old girl with long-standing juvenile dermatomyositis had an illness marked by intermittent clinical flares, including increased muscle weakness, joint contractures, photosensitive rashes, and dysphagia, despite treatment with multiple immunosuppressive drugs. At presentation, Gottron's papules, a heliotrope rash, and periungual capillary changes were visible, including dilated and tortuous blood vessels with areas of atrophy, telangiectases, and bushy loop formation along the fingernail bed (Panel A, arrows). The patient reported having had bleeding gums that had not responded to traditional dental treatment. Close examination of the mouth revealed markedly dilated capillaries in the attached gingiva, with bushy loop formations that spread . . . [Full Text of this Article] |
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