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Dermatology · Papulosquamous disorders: anti-MDA5 dermatomyositis
Sample itemA woman has Gottron papules, painful palmar papules that ulcerate, and minimal muscle weakness with a normal creatine kinase. Within weeks she develops rapidly progressive dyspnoea and hypoxia, and HRCT shows interstitial lung disease. Which autoantibody is most likely?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Anti-MDA5
Anti-MDA5 antibodies characterise clinically amyopathic dermatomyositis with skin ulceration, painful palmar papules and rapidly progressive interstitial lung disease that carries a high mortality. Muscle enzymes are often normal. Early aggressive immunosuppression is needed.
Option by option
A. Anti-Mi-2
Anti-Mi-2 is linked to classic dermatomyositis with a shawl sign and cuticular overgrowth and usually a good response.
B. Anti-SRP
Anti-SRP is linked to a necrotising myopathy with severe weakness and high creatine kinase.
C. Anti-TIF1 gamma
Anti-TIF1 gamma in adults signals an underlying cancer, not rapidly progressive lung disease.
D. Anti-MDA5 (correct)
Correct. Amyopathic disease with skin ulcers and rapidly progressive lung disease points to anti-MDA5.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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