Dermatomyositis, DVT, and D-Dimer

January 22, 2015

Norman Bauman

Pulmonary embolism and deep vein thrombosis developed in a 40-year-old man with amyopathic dermatomyositis. D-dimer levels were a red flag.

The patient with dermatomyositis eventually progressed to DVT and PE. D-dimer levels could have been a clue. Source: Kirchhof MG, Dutz JP. .Amyopathic DermatomyositisâRelated Thrombophilia. JAMA Dermatology. Online January 14, 2015. doi:10.1001/jamadermatol.2014.5070

As well as Gottron papules and nailfold changes, the patient had a history of fatigue. Source: Kirchhof MG, Dutz JP. .Amyopathic DermatomyositisâRelated Thrombophilia. JAMA Dermatology. Online January 14, 2015. doi:10.1001/jamadermatol.2014.5070

He was treated with hydroxychloroquine and clobetasol after a diagnosis of amyopathic dermatomyositis. When D-dimer levels shot up, methotrexate was added. Source: Kirchhof MG, Dutz JP. .Amyopathic DermatomyositisâRelated Thrombophilia. JAMA Dermatology. Online January 14, 2015. doi:10.1001/jamadermatol.2014.5070

Pleuritic chest pain developed. Testing confirmed DVT and PE. Methotrexate was increased and prednisone added. Symptoms improved; D-dimer levels normalized. Source: Kirchhof MG, Dutz JP. .Amyopathic DermatomyositisâRelated Thrombophilia. JAMA Dermatology. Online January 14, 2015. doi:10.1001/jamadermatol.2014.5070

A protein fragment resulting from fibrinolysis of a thrombus, D-dimer levels may indicate vasular damage. Source: Kirchhof MG, Dutz JP. .Amyopathic DermatomyositisâRelated Thrombophilia. JAMA Dermatology. Online January 14, 2015. doi:10.1001/jamadermatol.2014.5070 Image: Mpt-Matthew via Wikimedia Commons

D-dimer screening may identify patients with autoimmune disease who are at high risk of thrombosis. But its use has not been validated. Source: Kirchhof MG, Dutz JP. .Amyopathic DermatomyositisâRelated Thrombophilia. JAMA Dermatology. Online January 14, 2015. doi:10.1001/jamadermatol.2014.5070 image: By Flickr user dslrninja via Wikimedia Commons