Diagnostic challenges of dermatomyositis in a resource-limited setting: a case report

Abstract

Background: Dermatomyositis is a rare idiopathic inflammatory myopathy characterized by distinct cutaneous manifestations and progressive proximal muscle weakness. However, in areas with limited diagnostic tools without a high index of suspicion, early identification is often challenging, increasing the risk of complications. Case presentation: We report the case of a 50-year-old Ethiopian woman who presented with progressive difficulty swallowing, proximal muscle weakness, and characteristic dermatologic manifestations. Despite multiple emergency visits and extensive workups, such as chest computed tomography and barium swallow, the diagnosis was delayed. Key findings included elevated muscle enzymes and low serum albumin, and a muscle biopsy revealed muscle fiber atrophy. The diagnosis of dermatomyositis was confirmed by the American College of Rheumatology–European League Against Rheumatism classification criteria. Management: We treated the patient with high-dose prednisolone and methotrexate as a steroid-sparing agent, along with nutritional support. Her muscle strength and dysphagia significantly improved within weeks of therapy initiation. Conclusion: Our goal is to emphasize the importance of early recognition of dermatomyositis, especially in resource-limited settings, to avoid unnecessary, financially debilitating workups and prevent complications such as malnutrition, which are completely avoidable with early detection.