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DERMATOMYOSITIS AND SYSTEMIC LUPUS ERYTHEMATOSUS: I. A CLINICAL REPORT OF TRANSITIONAL CASES, WITH A CONSIDERATION OF LEAD AS A POSSIBLE ETIOLOGIC FACTOR

DERMATOMYOSITIS AND SYSTEMIC LUPUS ERYTHEMATOSUS: I. A CLINICAL REPORT OF TRANSITIONAL CASES,... Abstract During the past few years there has sprung up an abundant literature devoted to the subject of dermatomyositis. Despite this, it is commonly believed that this condition is extremely rare. Early in the course of my studies on lupus erythematosus1 it became apparent to me that there were resemblances between that disease and dermatomyositis. The belief that this was so was based on observations made in cases showing certain similarities in eruption, clinical course, general outcome and especially the occurrence of what seemed to be "transitional" conditions. Contrariwise, there were also encountered many features that appeared to provide fundamental points of distinction, particularly if one considered only typical examples of each disease. In following the courses in such cases it was not uncommon to find that the nature of the clinical picture was often variously interpreted by the dermatologist, internist, pediatrician, neurologist and even the orthopedist. This is also References 1. Keil, H.: (a) Relationship Between Lupus Erythematosus and Tuberculosis: A Critical Review Based on Observations at Necropsy , Arch. Dermat. & Syph. 28:765 ( (Dec.) ) 1933 2. Conception of Lupus Erythematosus and Its Morphologic Variants, with Particular Reference to "Systemic" Lupus Erythematosus , Keil Arch. Dermat. & Syph. 36:729 ( (Oct.) ) 1937 3. Relation Between "Systemic" Lupus Erythematosus and a Peculiar Form of Thrombocytopenic Purpura , Brit. J. Dermat. 49:221, 1937 4. The So-Called Libman-Sacks Syndrome , Arch. Dermat. & Syph. 34:124 ( (Jan.) ) 1936 5. Tuberculous Skin Lesions , New England J. Med. 218:783, 1938. 6. Berkowitz, B. B.: Case of Porokeratosis? Arch. Dermat. & Syph. 24: 1124 ( (Dec.) ) 1931. 7. Gottron. H.: Hautveränderungen bei Dermatomyositis, in Comptes-rendus du huitième Congres international de dermatologie et de syphilologie , Copenhagen, 1930, p. 826. 8. Aub, J. C.: Fairhall, L. T.; Minot, A. S., and Reznikoff, P.: Lead Poisoning , Baltimore, Williams & Wilkins Company, 1926. 9. Linenthal, H.: The Early Diagnosis of Lead Poisoning , J. A. M. A. 62: 1796 ( (June 6) ) 1914. 10. Waterfield, R. L.: A Case of Delayed Lead Poisoning with a Latent Period of Twenty-Four Years , Guy's Hosp. Rep. 81:374, 1931. 11. Zadek, E.: Zur Klinik der chronischen Bleivergiftungen , Ztschr. f. klin. Med. 116:241, 1931. 12. Teleky, cited by Zadek.7 13. Fishberg, A. M.: Hypertension and Nephritis , ed. 3, Philadelphia, Lea & Febiger, 1934. 14. Brogsitter, A. M., and Wodarz, H.: Nierenveränderungen bei Bleivergiftung und Gicht , Deutsches Arch. f. klin. Med. 139:129, 1922. 15. Volhard, F., and Fahr, K. T.: Die Brightsche Nierenkrankheit , Berlin, Julius Springer, 1914. 16. Keil, H.: The Rheumatic Subcutaneous Nodule and Simulating Lesions , Medicine 17:357, 1938. 17. Fahr, T.: Zur Frage der Polymyositis (Dermatomyositis) , Arch. f. Dermat. u. Syph. 130:1, 1921. 18. Lewis, T.: The Blood Vessels of the Human Skin and Their Responses , London, Shaw and Sons, Ltd., 1927. 19. Machwitz, H., and Rosenberg, M.: Zur Klinik der "vaskulären Schrumpfniere" Deutsche med. Wchnschr. 42:1188, 1916. 20. Löhlein, cited by Machwitz and Rosenberg.15 21. Gaylor, J.: Zur Histologie der Schrumpfniere nach chronischen Bleivergiftung , Beitr. z. path. Anat. u. z. allg. Path. 2:476, 1888. 22. Mott, F. W.: Examination of the Nervous System in a Case of Chronic Lead Encephalitis , Arch. Neurol. & Psychiat. Path. Lab., London 4:117, 1909. 23. Öller, J. N.: Ueber hyaline Gafässdegeneration als Ursache eine Amblyopia saturnina . Virchows Arch. f. path. Anat. 86:329, 1881. 24. Eichhorst, H.: Beiträge zur Pathologie der Nerven und Muskeln , Virchows Arch. f. path. Anat. 120:217, 1890. 25. Freifeld, H.: Zur Frage der pathologisch-anatomischen Veränderungen bei der Bleivergiftung , Virchows Arch. f. path. Anat. 268:456, 1928. 26. Blackman, S. S., Jr.: The Lesions of Lead Encephalitis in Children , Bull. Johns Hopkins Hosp. 61:1, 1937. 27. Brogsitter and Wodarz.10 28. Karelitz, S., and Welt, S. K.: Dermatomyositis , Am. J. Dis. Child. 43: 1134 ( (May) ) 1932. 29. Schuermann, H.: Zur Klinik und Pathogenese der Dermatomyositis (Polymyositis) , Arch. f. Dermat. u. Syph. 178:414, 1939.Crossref 30. This was probably an erroneous belief, as the features from the beginning were those of a case of originally unrecognized dermatomyositis. 31. Ludy, J. B., and Corson, E. F.: Lupus Erythematosus: Increased Incidence, Hematoporphyrinuria and Spectroscopic Findings , Arch. Dermat. & Syph. 37: 403 ( (March) ) 1938. 32. Traub, E.: A Case for Diagnosis (Lupus Erythematosus Disseminatus?) , Arch. Dermat. & Syph. 25:562 ( (March) ) 1932. 33. Pässler, H.: Acute Bleivergiftung bei Ekzem nach Behandlung mit Diachlonsalbe , München. med. Wchnschr. 41:85, 1894. 34. Gottheil, U. S.: Fatal Lead Poisoning from the Use of Burrow's Solution , J. A. M. A. 54:1056 ( (March 26) ) 1910. 35. Hahn: Encephalopathia saturnina bei einem 13 monatlichen Kinde durch Hebrasalbe: Tod, nebst Bemerkungen über die Eclampsie , Arch. f. Kinderh. 28: 172, 1900. 36. Holland, J. W., in Peterson, F., and Haines, U. S.: A Text-Book of Legal Medicine and Toxicology , Philadelphia, W. B. Saunders Company, 1904, vol. 2, p. 385. 37. Oliver, T.: Lead Poisoning , New York, Paul B. Hoeber, 1914. 38. Robinson, G. W.: Lead Poisoning from the Use of Cosmetics: Two Cases of the Neuromuscular Type , J. A. M. A. 64:814 ( (March 6) ) 1915. 39. Sante, L. R.: Lead Neuritis from Cosmetics, with Report of Two Cases , J. A. M. A. 64:1573 ( (May 8) ) 1915. 40. Woltman, H. W.: Lead Poisoning from Face Enamel , J. A. M. A. 79:1685 ( (Nov. 11) ) 1922. 41. Barron, M., and Habein, H. C.: Lead Poisoning, with Special Reference to Poisoning from Lead Cosmetics , Am. J. M. Sc. 162:833, 1921. 42. O'Carroll, J.: Saturnine Encephalopathy , Dublin J. M. Sc. 95:1, 1893. 43. Raynaud, M.: New Researches on the Nature and Treatment of Local Asphyxia and Symmetrical Gangrene of the Extremities , translated by T. Barlow, in Selected Monographs , London, The New Sydenham Society, 1888. 44. Cassirer, R.: Die vasomotorisch-trophischen Neurosen , ed. 2, Berlin, S. Krager, 1912. 45. Sainton, H.: Asphyxie symmétrique des extrémités et ménace de gangrène chez un saturnin , France méd. 1:221, 1881. 46. Timme, W.: A Case of Endarteritis Obliterans , Boston M. & S. J. 174:539, 1916 47. Obliterative Arteritis and Lead Poisoning , Lancet 2:162, 1916. 48. Decloux; Ribadeau-Dumas, and Sabaréanu: Localisations rares de la maladie de Raynaud , Presse méd. 10:783, 1902. 49. Mader: Angioneurosis spastica; Besserung , Jahrb. d. Wien. k. k. Krankenstalten 1:668, 1892. 50. Kazda, F.: Gangrän an den unteren Extremitäten bei Bleiarbeitern , Wien. klin. Wchnschr. 36:694, 1923. 51. Baader, E. W.: Beobachtungen an gewerblichen Bleivergiftungen auf der Abteilung für Berufskranke des Kaiserin Auguste Viktoria Krankenhauses zu Berlin-Lichtenberg , Opera collecta, congressus medicorum internationalis pro artificibus calamitate afflictis aegrotisque Budapest, 1928, p. 411. 52. Lederer, E.: Bleigangrän, schwere, bei einem Glass-schleifer , Samml. Vergiftungsfällen 3:115, 1932. 53. Rutishauser, E.: Bleigangrän und Encephalopathie , Virchows Arch. f. path. Anat. 297:119, 1936. 54. Curschmann, H.: Raynaudsche Krankheit (Symmetrica angiospastische Gangrän) , in von Bergmann, G., and Staehelin, R.: Handbuch der inneren Medizin , ed. 2, Berlin, Julius Springer, 1926, vol. 5, pt. 2, p. 1467. 55. Kolisko, cited by von Schrötter L.: Erkrankungen der Gefässe , in Nothnagel, H.: Specielle Pathologie und Therapie , Vienna, A. Hölder, 1901, vol. 15, pt. 3, sect. 2, p. 82. 56. Barker, N. W., and Brown, G. E.: Progressive Disseminated Obliterating Arteritis of Unknown Origin , M. Clin. North America 16:1313, 1933. 57. Barker, N. W., and Baker, T. W.: Proliferative Intimitis of Small Arteries and Veins Associated with Peripheral Neuritis, Livedo Reticularis, and Recurring Necrotic Ulcers of the Skin , Ann. Int. Med. 9:1134, 1936.Crossref 58. Seier: Lupus erythematodes exanthematicus , Zentralbl. f. Haut- u. Geschlechtskr. 40:175, 1932. 59. Blau, A.: Primary Generalized Myositis Fibrosa: Report of Two Cases with Histopathology , J. Mt. Sinai Hosp. 5:432, 1938. 60. Orzechowski, K.: Disseminierte chronische Myositis und Lupus erythematosis , Arch. f. Dermat. u. Syph. 137:369, 1921. 61. Davison, C.: Dermatomyositis: A Clinicopathologic Study; Report of a Case with a Complete Necropsy , Arch. Dermat. & Syph. 19:255 ( (Feb.) ) 1929. 62. Levy, I. J.: Personal communication to the author. 63. Weber, F. P., and Gray, A. M. H.: Chronic Relapsing Polydermatomyositis with Predominant Involvement of the Subcutaneous Fat (Panniculitis) , Brit. J. Dermat. 36:544, 1924. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

DERMATOMYOSITIS AND SYSTEMIC LUPUS ERYTHEMATOSUS: I. A CLINICAL REPORT OF TRANSITIONAL CASES, WITH A CONSIDERATION OF LEAD AS A POSSIBLE ETIOLOGIC FACTOR

Archives of Internal Medicine , Volume 66 (1) – Jul 1, 1940

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Copyright © 1940 American Medical Association. All Rights Reserved.
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Abstract

Abstract During the past few years there has sprung up an abundant literature devoted to the subject of dermatomyositis. Despite this, it is commonly believed that this condition is extremely rare. Early in the course of my studies on lupus erythematosus1 it became apparent to me that there were resemblances between that disease and dermatomyositis. The belief that this was so was based on observations made in cases showing certain similarities in eruption, clinical course, general outcome and especially the occurrence of what seemed to be "transitional" conditions. Contrariwise, there were also encountered many features that appeared to provide fundamental points of distinction, particularly if one considered only typical examples of each disease. In following the courses in such cases it was not uncommon to find that the nature of the clinical picture was often variously interpreted by the dermatologist, internist, pediatrician, neurologist and even the orthopedist. This is also References 1. Keil, H.: (a) Relationship Between Lupus Erythematosus and Tuberculosis: A Critical Review Based on Observations at Necropsy , Arch. Dermat. & Syph. 28:765 ( (Dec.) ) 1933 2. Conception of Lupus Erythematosus and Its Morphologic Variants, with Particular Reference to "Systemic" Lupus Erythematosus , Keil Arch. Dermat. & Syph. 36:729 ( (Oct.) ) 1937 3. Relation Between "Systemic" Lupus Erythematosus and a Peculiar Form of Thrombocytopenic Purpura , Brit. J. Dermat. 49:221, 1937 4. The So-Called Libman-Sacks Syndrome , Arch. Dermat. & Syph. 34:124 ( (Jan.) ) 1936 5. Tuberculous Skin Lesions , New England J. Med. 218:783, 1938. 6. Berkowitz, B. B.: Case of Porokeratosis? Arch. Dermat. & Syph. 24: 1124 ( (Dec.) ) 1931. 7. Gottron. H.: Hautveränderungen bei Dermatomyositis, in Comptes-rendus du huitième Congres international de dermatologie et de syphilologie , Copenhagen, 1930, p. 826. 8. Aub, J. C.: Fairhall, L. T.; Minot, A. S., and Reznikoff, P.: Lead Poisoning , Baltimore, Williams & Wilkins Company, 1926. 9. Linenthal, H.: The Early Diagnosis of Lead Poisoning , J. A. M. A. 62: 1796 ( (June 6) ) 1914. 10. Waterfield, R. L.: A Case of Delayed Lead Poisoning with a Latent Period of Twenty-Four Years , Guy's Hosp. Rep. 81:374, 1931. 11. Zadek, E.: Zur Klinik der chronischen Bleivergiftungen , Ztschr. f. klin. Med. 116:241, 1931. 12. Teleky, cited by Zadek.7 13. Fishberg, A. M.: Hypertension and Nephritis , ed. 3, Philadelphia, Lea & Febiger, 1934. 14. Brogsitter, A. M., and Wodarz, H.: Nierenveränderungen bei Bleivergiftung und Gicht , Deutsches Arch. f. klin. Med. 139:129, 1922. 15. Volhard, F., and Fahr, K. T.: Die Brightsche Nierenkrankheit , Berlin, Julius Springer, 1914. 16. Keil, H.: The Rheumatic Subcutaneous Nodule and Simulating Lesions , Medicine 17:357, 1938. 17. Fahr, T.: Zur Frage der Polymyositis (Dermatomyositis) , Arch. f. Dermat. u. Syph. 130:1, 1921. 18. Lewis, T.: The Blood Vessels of the Human Skin and Their Responses , London, Shaw and Sons, Ltd., 1927. 19. Machwitz, H., and Rosenberg, M.: Zur Klinik der "vaskulären Schrumpfniere" Deutsche med. Wchnschr. 42:1188, 1916. 20. Löhlein, cited by Machwitz and Rosenberg.15 21. Gaylor, J.: Zur Histologie der Schrumpfniere nach chronischen Bleivergiftung , Beitr. z. path. Anat. u. z. allg. Path. 2:476, 1888. 22. Mott, F. W.: Examination of the Nervous System in a Case of Chronic Lead Encephalitis , Arch. Neurol. & Psychiat. Path. Lab., London 4:117, 1909. 23. Öller, J. N.: Ueber hyaline Gafässdegeneration als Ursache eine Amblyopia saturnina . Virchows Arch. f. path. Anat. 86:329, 1881. 24. Eichhorst, H.: Beiträge zur Pathologie der Nerven und Muskeln , Virchows Arch. f. path. Anat. 120:217, 1890. 25. Freifeld, H.: Zur Frage der pathologisch-anatomischen Veränderungen bei der Bleivergiftung , Virchows Arch. f. path. Anat. 268:456, 1928. 26. Blackman, S. S., Jr.: The Lesions of Lead Encephalitis in Children , Bull. Johns Hopkins Hosp. 61:1, 1937. 27. Brogsitter and Wodarz.10 28. Karelitz, S., and Welt, S. K.: Dermatomyositis , Am. J. Dis. Child. 43: 1134 ( (May) ) 1932. 29. Schuermann, H.: Zur Klinik und Pathogenese der Dermatomyositis (Polymyositis) , Arch. f. Dermat. u. Syph. 178:414, 1939.Crossref 30. This was probably an erroneous belief, as the features from the beginning were those of a case of originally unrecognized dermatomyositis. 31. Ludy, J. B., and Corson, E. F.: Lupus Erythematosus: Increased Incidence, Hematoporphyrinuria and Spectroscopic Findings , Arch. Dermat. & Syph. 37: 403 ( (March) ) 1938. 32. Traub, E.: A Case for Diagnosis (Lupus Erythematosus Disseminatus?) , Arch. Dermat. & Syph. 25:562 ( (March) ) 1932. 33. Pässler, H.: Acute Bleivergiftung bei Ekzem nach Behandlung mit Diachlonsalbe , München. med. Wchnschr. 41:85, 1894. 34. Gottheil, U. S.: Fatal Lead Poisoning from the Use of Burrow's Solution , J. A. M. A. 54:1056 ( (March 26) ) 1910. 35. Hahn: Encephalopathia saturnina bei einem 13 monatlichen Kinde durch Hebrasalbe: Tod, nebst Bemerkungen über die Eclampsie , Arch. f. Kinderh. 28: 172, 1900. 36. Holland, J. W., in Peterson, F., and Haines, U. S.: A Text-Book of Legal Medicine and Toxicology , Philadelphia, W. B. Saunders Company, 1904, vol. 2, p. 385. 37. Oliver, T.: Lead Poisoning , New York, Paul B. Hoeber, 1914. 38. Robinson, G. W.: Lead Poisoning from the Use of Cosmetics: Two Cases of the Neuromuscular Type , J. A. M. A. 64:814 ( (March 6) ) 1915. 39. Sante, L. R.: Lead Neuritis from Cosmetics, with Report of Two Cases , J. A. M. A. 64:1573 ( (May 8) ) 1915. 40. Woltman, H. W.: Lead Poisoning from Face Enamel , J. A. M. A. 79:1685 ( (Nov. 11) ) 1922. 41. Barron, M., and Habein, H. C.: Lead Poisoning, with Special Reference to Poisoning from Lead Cosmetics , Am. J. M. Sc. 162:833, 1921. 42. O'Carroll, J.: Saturnine Encephalopathy , Dublin J. M. Sc. 95:1, 1893. 43. Raynaud, M.: New Researches on the Nature and Treatment of Local Asphyxia and Symmetrical Gangrene of the Extremities , translated by T. Barlow, in Selected Monographs , London, The New Sydenham Society, 1888. 44. Cassirer, R.: Die vasomotorisch-trophischen Neurosen , ed. 2, Berlin, S. Krager, 1912. 45. Sainton, H.: Asphyxie symmétrique des extrémités et ménace de gangrène chez un saturnin , France méd. 1:221, 1881. 46. Timme, W.: A Case of Endarteritis Obliterans , Boston M. & S. J. 174:539, 1916 47. Obliterative Arteritis and Lead Poisoning , Lancet 2:162, 1916. 48. Decloux; Ribadeau-Dumas, and Sabaréanu: Localisations rares de la maladie de Raynaud , Presse méd. 10:783, 1902. 49. Mader: Angioneurosis spastica; Besserung , Jahrb. d. Wien. k. k. Krankenstalten 1:668, 1892. 50. Kazda, F.: Gangrän an den unteren Extremitäten bei Bleiarbeitern , Wien. klin. Wchnschr. 36:694, 1923. 51. Baader, E. W.: Beobachtungen an gewerblichen Bleivergiftungen auf der Abteilung für Berufskranke des Kaiserin Auguste Viktoria Krankenhauses zu Berlin-Lichtenberg , Opera collecta, congressus medicorum internationalis pro artificibus calamitate afflictis aegrotisque Budapest, 1928, p. 411. 52. Lederer, E.: Bleigangrän, schwere, bei einem Glass-schleifer , Samml. Vergiftungsfällen 3:115, 1932. 53. Rutishauser, E.: Bleigangrän und Encephalopathie , Virchows Arch. f. path. Anat. 297:119, 1936. 54. Curschmann, H.: Raynaudsche Krankheit (Symmetrica angiospastische Gangrän) , in von Bergmann, G., and Staehelin, R.: Handbuch der inneren Medizin , ed. 2, Berlin, Julius Springer, 1926, vol. 5, pt. 2, p. 1467. 55. Kolisko, cited by von Schrötter L.: Erkrankungen der Gefässe , in Nothnagel, H.: Specielle Pathologie und Therapie , Vienna, A. Hölder, 1901, vol. 15, pt. 3, sect. 2, p. 82. 56. Barker, N. W., and Brown, G. E.: Progressive Disseminated Obliterating Arteritis of Unknown Origin , M. Clin. North America 16:1313, 1933. 57. Barker, N. W., and Baker, T. W.: Proliferative Intimitis of Small Arteries and Veins Associated with Peripheral Neuritis, Livedo Reticularis, and Recurring Necrotic Ulcers of the Skin , Ann. Int. Med. 9:1134, 1936.Crossref 58. Seier: Lupus erythematodes exanthematicus , Zentralbl. f. Haut- u. Geschlechtskr. 40:175, 1932. 59. Blau, A.: Primary Generalized Myositis Fibrosa: Report of Two Cases with Histopathology , J. Mt. Sinai Hosp. 5:432, 1938. 60. Orzechowski, K.: Disseminierte chronische Myositis und Lupus erythematosis , Arch. f. Dermat. u. Syph. 137:369, 1921. 61. Davison, C.: Dermatomyositis: A Clinicopathologic Study; Report of a Case with a Complete Necropsy , Arch. Dermat. & Syph. 19:255 ( (Feb.) ) 1929. 62. Levy, I. J.: Personal communication to the author. 63. Weber, F. P., and Gray, A. M. H.: Chronic Relapsing Polydermatomyositis with Predominant Involvement of the Subcutaneous Fat (Panniculitis) , Brit. J. Dermat. 36:544, 1924.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jul 1, 1940

References