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Introduction Idiopathic inflammatory myopathies (IIM) are a group of conditions characterised by immune-driven muscular inflammation, often in the presence of specific autoantibodies. NXP2 dermatomyositis is a subtype of IIM characterised by antibodies to nuclear matrix protein 2. NXP2 dermatomyositis is associated with calcinosis, especially in younger patients and with malignancy, especially in older patients. We report a case of NXP2 dermatomyositis in a female patient of West African descent presenting with a periorbital and upper back rash which was initially misdiagnosed as an allergic reaction. Images of darker skin are underrepresented in medical education around dermatomyositis. Case description A 49-year-old female office worker presented to A&E with a two-week history of arthralgia and fatigue. Over the past two days, she had also noticed the development of periorbital swelling and a rash on her eyelids and her upper back. On examination in A&E, the rash was considered minor and it was noted that she had difficulty taking off her coat due to pain in her arms. She was discharged home with a working diagnosis of an allergic reaction, with advice to see her GP if symptoms persisted. She was reviewed by her GP, who suspected a vasculitic rash. She was found to have a significantly raised ANCA-MPO antibody titre and was referred to the acute medical take where she was seen urgently by rheumatology on-call. On assessment, she was noted to have pain and morning stiffness in her hands and wrists, with swollen DIPJ, MCPJ and wrists on examination. On assessment by a rheumatologist aware of the skin manifestations of dermatomyositis, she was also noted to have a heliotrope rash, shawl sign, periungual erythema, and a V sign rash and was suspected to have dermatomyositis. Her CK was raised at 3000, and she was found to have NXP2 autoantibodies which confirmed the diagnosis. She was started on hydroxychloroquine whilst an MR scan of her arms and legs was organised, which revealed evidence of ... |