Pediatric emergency medicine trisk 2971 2971
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FIGURE 101.4 Coronal fast multiplanar inversion recovery image of the thighs shows areas of
increased signal intensity, especially in the adductor muscle groups, in a patient with dermatomyositis.
Weakness is a consistent manifestation of JDM, but it is a variable and subjective
clinical sign. Objective evidence of muscle inflammation should also be sought by
measuring serum levels of muscle enzymes. A wide variety of enzymes may be
elevated in JDM, including creatine kinase (CK), aldolase, lactate dehydrogenase
(LDH), and transaminases (ALT and AST). These markers must be interpreted with
caution, however, because none is specific for muscle. Further, for unknown reasons
many children do not reliably demonstrate elevated muscle enzymes despite significant
myositis. This is particularly true during later stages of the disease, when subtle
increases in LDH and aldolase may herald a disease flare-up, but CK levels often
remain normal. While myositis-specific antibodies (MSAs) have demonstrable utility
in the diagnosis of adult DM, their utility in pediatric cases is an area of active
