A 16 year old female with long-standing juvenile dermatomyositis has had a course of illness marked by intermittent clinical flares, which have included increased muscle weakness, joint contractures, photosensitive skin rashes, and dysphagia. At this visit, 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 (panel A). She complained of bleeding gums that had not responded to traditional dental treatment. Close examination of the mouth revealed marked dilation of the capillaries of the attached gingiva with bushy loop formations that spread over the crowns of the teeth (panel B). These areas reflect the vasculopathy associated with dermatomyositis, particularly in its juvenile form. Periungual capillary changes have been reported frequently in patients with juvenile dermatomyositis, whereas the accompanying gingival changes are often present but rarely recognized.
Panel A.
Periungual capillary changes in a 16 year female with active juvenile dermatomyositis. Dilated and tortuous blood vessels with areas of atrophy, telangiectases, a central area of hemorrhage, and bushy loop formation (indicated by arrows) are pictured.
Panel B.
Close examination of the mouth from the same patient revealed marked dilation of the capillaries of the attached gingiva with bushy loop formations (indicated by arrows) that spread over the crowns of the teeth.
Acknowledgments
This research was supported in part by the intramural programs of NIEHS and NICDR, NIH, DHHS.
Contributor Information
Lisa G. Rider, Environmental Autoimmunity Group National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services CRC 4-2332, MSC 1301 10 Center Drive Bethesda, MD 20892-1301 Phone: 301-451-6272 FAX: 301-451-5588 riderl@mail.nih.gov.
Jane C. Atkinson, National Institute of Craniofacial and Dental Research, National Institutes of Health, Department of Health and Human Services 10 Center Drive, CRC Room 1N-117 MSC 1191 Bethesda, Maryland 20892-1191 301-594-9726 jatkinso@mail.nih.gov.