Persistently elevated transaminases in a child with dermatomyositis MDA5

Abstract

Introduction: Dermatomyositis is the most common inflam­matory myopathy in childhood. In children, there is little data on the prevalence of autoantibodies and their associations, so here its presented an atypical case with a good response to rescue therapy. Clinical case: 6-year-old patient develops erythematous macules on the eyelids, erythematous papules on the palms, ears, nostrils, and ulcerative lesions on the elbows associated with fatigue. Total creatine kinase was slightly elevated with very elevated transamina­ses (more than 1,000). Inflammatory myopathies panel was positive to MDA5. Treatment was started with prednisone 2 mg/kg per day without improvement in the elevation of transaminases. Gamma globulin 2 g/kg was administered with a decrease in transaminases, so methotrexate 15 mg/m² weekly was initiated. The patient has remained inactive for 6 months since debut. Conclusions: The stu­dy with autoantibodies has allowed patients with dermatomyositis to be phenotyped into disease subgroups, which has contributed to improving diagnosis, therapy, follow-up and prognosis.