Pediatric Patient with Heliotrope Rash and Proximal Muscle Weakness


      • Juvenile dermatomyositis is the most common idiopathic inflammatory myopathy of childhood.
      • Clinical features of juvenile dermatomyositis include proximal muscle weakness, rash, and joint pain.
      • Treatment guidelines published by the Childhood Arthritis and Rheumatology Research Alliance (CARRA) offer a consensus on the treatment of moderately severe juvenile dermatomyositis in the first 2 months after diagnosis.


      Patients presenting with progressive muscle weakness, who are otherwise ambulatory, may be difficult to evaluate. The differential diagnoses for a pediatric patient with progressively worsening weakness, heliotrope rash, joint pain, and fatigue can be broad. This case challenge highlights the case of an 8-year-old girl who presents with the aforementioned symptoms and will review important items in the history and physical examination to consider when narrowing this list of differentials. Diagnostic evaluation, management, and patient and family teaching are reviewed.


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      Anna Richmond, DNP, FNP-C, PNP-PC, is an assistant professor of nursing at Vanderbilt University of School of Nursing and the Department of Pediatrics at Monroe Carrell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, and can be contacted at [email protected]