Can you get this one?

Rajiv Ranjan Kumar DM
Consultant Rheumatologist, CK Birla Hospital Gurugram & Medgram, Gurugram 

A young hypothyroid male, presented with acute onset pain, redness, and swelling on the left side face. NCCT & MRI of the face was suggestive of cellulitis, soft tissue edema with left masseter muscle edema. Two months later, he developed acute onset, symmetrical, additive, inflammatory polyarthritis (small & large joints). Blood investigations revealed persistent leucopenia, Positive RF, and anti-CCP with high ESR & CRP. ANA by IFA,ENA profile, C3, and C4 all were negative. CT chest and abdomen were normal. Bone marrow aspiration was suggestive of hypocellular marrow. PET scan was negative for malignancy. These skin lesions gave us the clue.


  1. What are these skin lesions?
  2. What is the clinical diagnosis?

Answer: These clinical pictures reveal Gottron’s sign and inverse Gottron’s sign. Myositis antibody profile was done. The anti-MDA5antibody was positive. The patient was diagnosed with Overlap Syndrome of seropositive Rheumatoid arthritis and Clinically amyopathic Dermatomyositis (CADM, MDA-5+).