The article examines the objective, findings, and clinical context described in Sleeve and Holster Skin Signs Associated With Dermatomyositis.
Approach:
Case presentation: A 76-year-old woman with progressive extremity erythema, proximal weakness, dysphagia, and dysphonia was diagnosed with anti-NXP-2-positive dermatomyositis.
Evaluation: Examination showed bilateral lateral upper-arm and lateral thigh erythema, along with other cutaneous findings. CK was 714 U/L; MRI showed muscle STIR hyperintensity, and a skin biopsy was suggestive of dermatomyositis.
Treatment and course: After immunosuppressive therapy, erythema and muscle strength improved, and CK normalized.
Key Findings:
The lateral upper-arm lesions were consistent with the sleeve sign; the lateral hip and proximal-thigh lesions were consistent with the holster sign.
The patient also had posterior neck, forehead, and dorsal hand erythema, dilated nailfold capillaries, muscle weakness, and aspiration of liquid on swallowing evaluation.
The article describes both signs as characteristic, but not pathognomonic, cutaneous manifestations of dermatomyositis.
The holster sign has been reported in 40%–51% of adults with dermatomyositis; the sleeve sign is comparatively uncommon and less widely recognized.
Interpretation:
The authors state that dermatomyositis should be considered when bilateral proximal-extremity erythema occurs with muscle weakness, even if classic cutaneous findings are absent.
Limitations:
This is a single-patient case presentation.
The sleeve and holster signs are not pathognomonic for dermatomyositis.
