Exploring the landscape of flagellate erythema as a rare cutaneous symptom of idiopathic inflammatory myopathy: a case series-based review.
Aleksandra Opinc-Rosiak, Milena Kaszubska, Aleksandra Nadel et al.
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Case in brief
Two patients with idiopathic inflammatory myopathy developed zebra-like flagellate erythema: one had immune-mediated necrotising myopathy and the other anti-Mi-2-positive cancer-associated myositis. In both, the skin eruption coincided with worsening myositis. The authors also reviewed 34 previously published cases, finding varied myositis subtypes and antibody profiles; malignancy was reported in 9 of 34, and approximately one-fifth had a fatal outcome. The cases broaden the reported clinical and serological spectrum, but the case-report-based literature does not establish a definitive association with any single subgroup.
What made this case unusual
The report describes flagellate erythema in immune-mediated necrotising myopathy, an association not previously reported, alongside a case of anti-Mi-2-positive cancer-associated myositis.
Diagnostic / clinical pearl
When flagellate erythema occurs in a patient with myositis, consider possible disease exacerbation and assess for flare; malignancy evaluation may also be appropriate, guided by the clinical context.