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Infections and neoplastic lesions are possible complications of ILD in dermatomyositis patients under immunosuppressive therapy, and the radiological characteristics of the lesion may not be enough for proper discrimination. We report the case of a 69-year-old woman, a never-smoker, with anti-melanoma differentiation-associated gene-5 (MDA5) antibody-positive amyopathic dermatomyositis (ADM) and autoimmune thrombocytopenia anti-glycoprotein IIb/IIIa antibodies. [Extracted from the article]

Cutaneous lesions presenting on admission: (A) dorsal left foot necrotic lesion; (B) plantar lesions resembling Janeway lesions; (C) thigh lesions resembling Janeway lesions; (D) finger lesions resembling Janeway lesions Physical examination revealed a previously unknown heart murmur. Given the presence of severe skin manifestations, lung involvement, and systemic symptoms, the patient was promptly treated with intravenous methylprednisolone pulses (1 g/day on 3 consecutive days) and six cyclophosphamide pulses [15 mg/kg, according to the European Vasculitis Study Group (EUVAS) scheme]. Based on the patient's history, current clinical presentation, and MPO-ANCA positivity, along with negative microbiological tests, a diagnosis of EGPA was confirmed. [Extracted from the article]