Dermatomyositis (DM) is a rare inflammatory disorder affecting the muscle and skin. DM patients can present with spontaneous muscle hemorrhage, a potentially fatal complication. The best practice for management of hemorrhagic myositis in these patients remains unclear. Here we discuss the case of a patient who presented with progressive muscle weakness and intermittent rash that was diagnosed with dermatomyositis. During admission, she developed spontaneous hemorrhagic myositis of the right pectoralis major treated with surgical evacuation. She also developed a spontaneous left anterior thigh hematoma which was treated conservatively. She recovered and showed no evidence of recurrent bleeding at either location. We performed a literature review and identified ten cases of spontaneous hemorrhage in DM patients, with a 60% mortality rate among reported cases. Given the high mortality rate associated with spontaneous hemorrhage in DM patients, it is important for physicians to be aware of the diagnosis, workup, and management strategies.

中文翻译：

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在皮肌炎中出血性肌炎的管理难题。

皮肌炎（DM）是一种罕见的炎症性疾病，会影响肌肉和皮肤。DM患者可出现自发性肌肉出血，这可能是致命的并发症。在这些患者中治疗出血性肌炎的最佳实践仍不清楚。在这里，我们讨论一例患有进行性肌无力和间歇性皮疹的患者，该患者被诊断为皮肌炎。入院期间，她患有右胸大肌的自发性出血性肌炎，接受了手术疏散治疗。她还发展为自发性左大腿前部血肿，经保守治疗。她康复了，没有发现任何部位反复出血的迹象。我们进行了文献综述并确定了DM患者的十例自发性出血，在报告的病例中死亡率为60％。鉴于DM患者自发性出血相关的高死亡率，医生必须了解诊断，检查和治疗策略，这一点很重要。