Rheumatology Question 4

A 46-year-old woman is evaluated for a 3-month history of a rash during the summertime. She is otherwise well and takes no medications.

On physical examination, vital signs are normal. BMI is 23. Examination of the skin reveals eyelid swelling and a periorbital violaceous rash, erythema and poikiloderma of the anterior chest and upper back, and an erythematous papular rash on the hands; there is no malar eruption, skin thickening, or digital ulcers. Muscle strength and reflexes are normal.

The appearance of the hands is shown.

Laboratory studies:

Complete blood count

Normal

Chemistry panel

Normal

Aldolase

5.1 U/L (normal range, 1.0-8.0 U/L)

Creatine kinase

100 U/L

Antinuclear antibodies

Titer of 1:640

Anti–Jo-1 antibodies

Negative

Urinalysis

Normal

Electromyogram and chest radiograph are normal.

Which of the following is the most likely diagnosis?

Amyopathic dermatomyositis

Polymorphous light eruption

Rosacea

Systemic lupus erythematosus

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