It's not Just Growing Pains: A Guide to Childhood Muscle, Bone, and Joint Pain, Rheumatic Diseases, and the Latest Treatments

By Thomas J. A. Lehman | Go to book overview

16
Dermatomyositis and
Polymyositis

Hillary was a delightful four-year-old. She had a younger sister who
was just beginning to walk when the family noticed that Hillary was
asking to be carried and holding on much more often than she had
previously. Her family thought this was a reaction to the increased
attention given to her sister. But the next month she became increas-
ingly “difficult.” She often refused to walk and had tantrums if her
family would not carry her. Hillary’s bedroom was on the second floor.
Although she would come downstairs in the morning, she insisted on
being carried up to bed every night. One morning she wanted a doll
from her bedroom but refused to go up the stairs to get it. The family
could not understand why she was getting so lazy. Over the next few
weeks they noted she was holding on to the stair rail with both hands
when coming down the steps and seemed to be falling unexpectedly.

Concerned, the family brought her to the pediatrician. On exami-
nation she was weak and could hardly get up from a chair. She could
not get up off the floor without assistance, and even when she was
given help getting started, she needed to push herself up the front of
her legs to rise to a standing position (this is called a positive Gower
sign). Laboratory evaluation revealed an elevated erythrocyte sedi-
mentation rate, elevated muscle enzymes, and elevated liver enzymes.
She was referred for evaluation.

In the office Hillary could grab my fingers tightly with her hand but
could not raise her arms over her head and could not lift her legs off
the exam table. She had reddened and irritated elbows and knees.
The family ascribed this to her frequent falling. She also had a pinkish
rash over her eyelids that the family had not noticed. The diagnosis of
dermatomyositis was made. She was begun on a low dose of cortico-
steroids, and within six months she had recovered completely.

-221-

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It's not Just Growing Pains: A Guide to Childhood Muscle, Bone, and Joint Pain, Rheumatic Diseases, and the Latest Treatments
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