A 44-year-old woman was referred to the Internal Medicine clinic with a six months history of generalized, worsening myalgia, Raynaud's phenomenon and muscular weakness. These symptoms were associated with asthenia and a weight loss of 5 Kg. Physical examination revealed a stony-hard left axillary lymphadenopathy, bilateral 3/5 quadriceps strength and hyperkeratotic skin lesions depicted in Fig. 1; the remainder of the examination, including breast examination, was normal. Blood tests showed elevated creatinphosphokinase (6363 UI/L), lactate dehydrogenase (779 UI/L), aspartate aminotransferase (156 UI/L), alanine amininotransferase (183 UI/L), and aldolase (159 UI/L); the rest of the tests were anodyne.
