Anti-melanoma differentiation-associated gene 5 antibody-positive clinically amyopathic dermatomyositis in a patient with silicone breast implants

The running title: CADM associated with SBI surgeries Manuscript word count: 695 silicone bag in both breasts (Fig. 1c). Moreover, the buttocks and vastus lateralis muscles 20 showed increased signal intensity on magnetic resonance imaging. Skin biopsy revealed 21 hyperkeratosis and liquefaction degeneration of the epidermis, lymphocytic infiltration 22 around blood vessels, and edema of the upper layer (Fig. 1d). The rheumatologist in our 23 hospital administered oral 60 mg (1mg/kg/day) of prednisolone and 150 mg of cyclosporine to the patient, and the arthritis and skin rash improved within 1 week.Steroids were tapered, and symptoms improved. We are suggesting that the patient 26 undergo resection of the SBI, but consent is not obtained yet. Three years after starting 27 treatment, the dose of prednisone is reduced to 7 mg (0.12 mg/kg/day), and there has been 28 no recurrence of the skin lesions or pneumonia.To our knowledge, seven cases of DM have been reported as ASIA, developing after 30 SBI surgery. This includes two intractable cases that improved after SBI removal, and 31 cases that developed after SBI rupture 2,3 (supplemental table). These cases suggest a 32 potential association between SBI and DM. However, there are also reports of DM