Case 8 History The patient is a 37-year-old female with a PMH of generalized anxiety disorder, and major depressive disorder who is admitted for worsening dysphagia and myalgia. The patient was seen by her rheumatologist for weeks of subjective muscle weakness, skin rash, left medial elbow swelling, and ANA 1:1280. She was found to have elevated IgG, +anti-NXP-2 (P140), +anti-SSA, and +anti-RNP. She has been experiencing symptoms since late February 2026. She was seen by rheumatology for escalating symptoms following an ED visit on 5/18, where she presented with rapidly progressive diffuse pain, weakness, and worsening dysphagia. She was seen in outpatient rheumatology on 6/23. CK was normal, and aldolase was elevated. MRI of the thighs showed findings concerning for myositis. Rheumatology suspected inflammatory idiopathic myositis vs eosinophilic fasciitis. Routine H&E examination showed inflammation along with a hint of perifascicular atrophy suggesting dermatomyositis.
