Germination

...and she says: "What a life!"

August 10, 2011

Day 8

THE GRAND ROUND

I never knew what a grand round was until today. It's basically like a session where all physicians are present and they discuss about a medical case. And today, they discussed about this condition called Dermatomyositis. It is a disease that involves the skin and muscles of the body.

Patient was 21 years old when she was diagnosed with hypertension and was given beta-blocker to bring down her hypertension. After 5 years she stopped the drug as she felt well. However, she started the feel lethargic and rashes started to appear on her skin. She couldn't do simple exercises and had to quit her job. She was then referred to this hospital from Sibu and initially they thought that she was having heart failure. So when they sent her to Sarawak International Medical Centre, she was diagnosed with no cardiac events! However, her CPK enzyme was high (CPK enzymes are released from muscles so it is not specific to the heart). So then she was sent to SGH for rheumatology unit and they started to identify signs and symptoms that she presented. One of the most prominent one was Gottron's papules. There is also proximal muscle weakness. And so the story went on and she was diagnosed with dermatomyositis. She was then screened for any malignancy. Apparently, in a few studies, it was indicated that there is a higher chance of patient who has dematomyositis to have nasopharyngeal carcinoma. And, an important point to note, dermatomyositis is closely related to malignancy.

Gottron's papules- macular

A differential diagnosis for dermatomyositis is polymyositis. However, the differences between this two diseases are:

1. Dermatomyositis is caused by antigen-antibody complex that accumulates at the tissues that causes the manifestations of the disease.

Polymyositis is a delayed hypersensitivity reaction.

2. Dermatomyositis is a strong malignant condition.

Polymyositis has a low connection with malignancy.


Remember that when doing a confirmative diagnostic test, muscle biopsy should always be taken from the most normal muscle not those which has atrophied AND muscle biopsy should NOT be done after electromyography(EMG) as during EMG, the muscles are excited and is traumatic to the muscle which gives an inaccurate test result.

This is an autoimmune disease and is common in women. So, to know more about the disease, one should read up on it. This post is just a personal note and reference so do not fully rely on what is written here.

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