Cutaneous involvement in
dermatomyositis can be the prevalent component of disease, failing to respond to adequate
therapies for
myositis. In this case report, we describe a patient affected by
dermatomyositis, characterized by prevalent skin involvement, successfully treated with Staphylococcus
protein A-based extracorporeal immunoadsorption (Immunosorba, Fresenius Medical Care AG & Co. KGaA, Bad Homburg, Germany) and
thalidomide. The patient showed panniculitic ulcerative lesions of the skin, difficult to treat because of side effects or ineffectiveness of various
therapies.
Skin manifestations rapidly improved after introduction of immunoadsorption; The association of
thalidomide allowed a good maintenance of these results until the remission of skin lesions, despite several infective complications of some residual
ulcers. Considering the difficulties in the management of our patient, combined
therapy with Immunosorba and
thalidomide has allowed a good clinical response. If confirmed, the observed beneficial effects suggest that
protein A-based immunoadsorption and
thalidomide can represent an alternative option in
dermatomyositis, especially when cutaneous manifestations are predominant.