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Routine, rapid, noninvasive diagnosis of viral skin exanthems

reaction and a superimposed mixed acute on chronic inflammatory infiltrate with focal leucocytoclasis (Fig. 2). The leg biopsy was nonspecific. Direct immunofluorescence was negative. These findings were most consistent with a drug-induced reaction. Given that the eruption and muscle weakness began 3 days after commencement of omeprazole, this was considered the likely cause. Omeprazole was replaced with ranitidine hydrochloride 300 mg daily, and mometasone furoate ointment twice daily was prescribed for the rash. On review after 1 week, the patient had less muscle weakness and was able to lift both of her arms above her head. Her rash had also settled significantly with less erythema and oedema, particularly over her dorsal hands. In summary, we have reported what we believe to be the first case of omeprazole-induced dermatomyositis. Druginduced dermatomyositis-like reactions are rare. They have been described in association with chemotherapeutic agents (hydroxycarbamide, cyclophosphamide and etoposide), D-penicillamine, nonsteroidal anti-inflammatory drugs (aspirin, diclofenac and phenylbutazone), anti-infectious agents (penicillins, sulphonamides and isoniazid) and lipid lowering drugs (nicotinic acid, fibrates and statins). With the widespread use of omeprazole, it is likely that this dermatomyositis-like reaction may occur in more patients than we recognize. We believe that a drug history is important when assessing a patient with dermatomyositis.