PMID: 40352703 https://pubmed.ncbi.nlm.nih.gov/40352703/

Abstract

UNLABELLED: Juvenile dermatomyositis (JDM) is an uncommon autoimmune illness with unexplained origin. It affects the skin, skeletal muscles, and blood vessels. This case report emphasizes an unusual case of an 8-year-old girl from Ninevah in Iraq, who presented with limb weakness and rash. She had a family history of hepatocellular carcinoma. The patient had hall mark features of JDM: heliotrope rash, Gottron's papules, and progressive proximal muscle weakness as well as elevated muscle enzymes. A positive hepatitis B surface antigen with high viral load proved concomitant infection. Treatment started with entecavir and intravenous immunoglobulins, followed by methotrexate and corticosteroids leading to steady clinical improvement. Effective antiviral treatment in combination with immunosuppressants is crucial for treating autoimmune diseases without infection reactivation. The correlation between hepatitis B infection and JDM is still obscure. This case suggests that that hepatitis B may lead to autoimmune diseases when there is a genetic susceptibility. This example adds to the scarce literature on JDM connection with viral hepatitis, highlighting the importance of being alert and using specialized treatment approaches in such cases.

LEARNING POINTS: highlights the difficulties in diagnosing autoimmune and viral disorders by presenting a rare case of concurrent juvenile dermatomyositis and chronic hepatitis B infection. emphasizes the significance of controlling the risk of viral reactivation and screening for hepatitis B prior to immunosuppressive treatment. highlights the importance of a multidisciplinary approach and provides internists with useful knowledge on how to provide individualized care in complicated rheumatic situations.