Pyoderma Gangrenosum As Early Manifestation of Dermatomyositis

Abstract

An elderly female in her 60s with multiple comorbidities presented with chronic lower limb ulcers. After a skin biopsy, the patient was diagnosed with pyoderma gangrenosum, and immunosuppressive therapy was initiated; however, the lesions remained refractory. Ten years later, she developed seronegative rheumatoid arthritis and was started on methotrexate, corticosteroids, and later adalimumab, resulting in partial improvement. In 2025, the patient developed proximal muscle weakness along with multiple other systemic manifestations. Following extensive laboratory and imaging investigations, a diagnosis of dermatomyositis was finally established.

This case represents an unusual presentation and a challenging diagnosis of Dermatomyositis.