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Fig. 1 | BMC Rheumatology

Fig. 1

From: Anti-MDA5 juvenile idiopathic inflammatory myopathy with second-degree heart block but no skin or lung involvement: a case report

Fig. 1

Representative images from an adolescent with anti-MDA5 JIIM. a Pelvis and thigh MRI without contrast coronal STIR view demonstrating patchy increased signal intensity. b Absence of rash on hands c Normal non-contrast chest computed tomography, axial view d Muscle biopsy stained with the indicated dyes or antibodies. H&E, i: Perimysial (black arrow) and endomysial (yellow arrow) inflammatory infiltrates. H&E, ii: Highlights marked fiber size variation with perifascicular atrophy with fibers showing purple discoloration and disrupted internal architecture (black arrow), perivascular inflammation (yellow arrow), many muscle fibers have central nuclei and vacuolar degeneration (arrowhead). Acid Phosphatase: Red staining predominantly in perimysium highlights inflammation involving histiocytes. Alkaline Phosphatase: Black staining highlights perimysial connective tissue reactivity. ATPase shows highlights of perifascicular atrophy and patchy loss of staining indicative of necrosis and degeneration (black arrow). Anti-CD68 staining localized to areas of inflammation involving histiocytes, especially in perimysium (arrows). Anti-CD3 and CD8 staining localized to areas of T-cell lymphocytic infiltrates (arrows). e Telemetry: top: Bradycardia with Wenckebach; bottom: 2:1 atrioventricular block

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