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March 6, 1978

Acute Hepatitis B Simulating Dermatomyositis

Author Affiliations

From the Division of Rheumatology, Department of Medicine, University of California School of Medicine and Veterans Administration Hospital, San Francisco (Dr Pittsley); and the Department of Medicine, Kaiser-Permanente Medical Center, Oakland, Calif (Drs Shearn and Kaufman).

JAMA. 1978;239(10):959. doi:10.1001/jama.1978.03280370055026

NEW extrahepatic manifestations of hepatitis B virus (HBV) infection continue to be recognized. We present a case of acute hepatitis B fulfilling generally accepted criteria for dermatomyositis (DM). This simulation calls attention to another exclusion to be considered before diagnosing DM, and illustrates masking of liver disease by myopathy. We are not aware of a previous report of myopathy complicating acute HBV.

Report of a Case  A 17-year-old girl in excellent previous health was hospitalized with complaints of malaise, vomiting, joint pain, and a pruritic skin rash. She denied fever, Raynaud's phenomenon, myalgia, morning stiffness, photosensitivity, and symptoms of polyserositis. She took no medication.Temperature and other vital signs were normal. Malar erythema, a dusky-purple induration with overlying telangiectasia of the upper eyelids, and an erythematous maculopapular eruption over the lower extremities were noted. Marked weakness of the neck flexor muscles and moderate symmetric weakness of the deltoids and the