امرأة عمرها ٤٠ سنة عندها ضعف تدريجي في الكتفين والفخذين منذ ٣ أشهر، صعوبة في صعود الدرج وتمشيط الشعر، وطفح بنفسجي حول العينين، وحطاطات حمراء على مفاصل الأصابع. إنزيم CK مرتفع. ما الأرجح؟

A 40-year-old woman has had progressive shoulder and thigh weakness for 3 months, difficulty climbing stairs and brushing her hair, a violet rash around the eyes and red papules over the finger joints. CK is raised. What is most likely?

1. Fibromyalgia
2. Myasthenia gravis
3. Amyotrophic lateral sclerosis
4. Dermatomyositis

Answer: D) Dermatomyositis. Proximal weakness with a heliotrope rash, papules over the knuckles and raised CK indicate dermatomyositis; adults are screened for associated cancer and treated with steroids.