{
  "abstract": "Flagellate erythema is an exceptionally rare cutaneous manifestation of idiopathic inflammatory myopathies (IIM) with poorly understood clinical significance. We report two patients who developed zebra-like flagellate erythema: one with immune-mediated necrotising myopathy (IMNM) and one with anti-Mi-2-positive cancer-associated myositis (CAM). To place these observations in broader context, we performed a thorough literature search across PubMed, Scopus and Embase and identified 34 previously published cases of IIM-associated flagellate erythema. The most frequent underlying diagnosis was dermatomyositis (n = 14, 41.2%), followed by CAM (n = 9, 26.5%), amyopathic/clinically amyopathic dermatomyositis (n = 6, 17.6%), and juvenile dermatomyositis (n = 5, 14.7%). Anti-TIF1-γ antibodies were identified in 6 of 34 patients (17.6%) and anti-MDA5 antibodies in 7 of 34 (20.6%); malignancy was reported in 9 of 34 (26.5%), while a substantial proportion of cases were seronegative or lacked antibody testing. Muscle weakness or myalgia was present in most of the combined cohort, and a fatal outcome was reported in approximately one-fifth of cases. Our cases expand the clinical and serological spectrum of myositis-associated flagellate erythema, including the first report of this presentation in IMNM. While flagellate erythema has most often been reported with CAM or anti-TIF1-γ antibodies, the literature remains inconsistent, and current case-report-based evidence does not support a definitive association with any single serological or clinical subgroup. In our patients, flagellate erythema coincided with disease exacerbation; although this should be interpreted cautiously given the limited evidence, its occurrence may warrant careful evaluation for IIM flare and, where appropriate, malignancy screening.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Rheumatology, Medical University of Lodz, Zeromskiego 113, 90-549, Lodz, Poland. aleksandra.opinc@umed.lodz.pl.",
    "Department of Rheumatology, Medical University of Lodz, Zeromskiego 113, 90-549, Lodz, Poland."
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Aleksandra Opinc-Rosiak",
      "orcid": "0000-0002-7881-5731"
    },
    {
      "affs": [
        1
      ],
      "name": "Milena Kaszubska",
      "orcid": "0009-0009-3494-5997"
    },
    {
      "affs": [
        1
      ],
      "name": "Aleksandra Nadel",
      "orcid": "0009-0005-3021-0150"
    },
    {
      "affs": [
        1
      ],
      "name": "Aleksander Sztajnert",
      "orcid": "0009-0002-3541-7220"
    },
    {
      "affs": [
        1
      ],
      "name": "Joanna Makowska",
      "orcid": "0000-0003-2036-375X"
    },
    {
      "affs": [
        1
      ],
      "name": "Anna Lewandowska-Polak",
      "orcid": "0000-0002-8389-7399"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fd025y4apqbd0.bib",
  "cited_by": 0,
  "doi": "10.1007/s00296-026-06328-5",
  "fulltext_url": "https://europepmc.org/articles/PMC13668962",
  "id": "fd025y4apqbd0",
  "issns": [
    "0172-8172",
    "1437-160X"
  ],
  "landing_url": "https://europepmc.org/article/MED/42873265",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2713|Inflammatory Myopathies and Dermatomyositis"
    ]
  ],
  "openalex": "W7221759931",
  "pdf_url": "https://europepmc.org/articles/PMC13668962?pdf=render",
  "pmcid": "PMC13668962",
  "pmid": "42873265",
  "published": "2026-10-14",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/fd025y4apqbd0.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:46Z",
      "native_id": "MED:42873265",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42873265"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Inflammatory Myopathies and Dermatomyositis",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Exploring the landscape of flagellate erythema as a rare cutaneous symptom of idiopathic inflammatory myopathy: a case series-based review.",
  "title_text": "Exploring the landscape of flagellate erythema as a rare cutaneous symptom of idiopathic inflammatory myopathy: a case series-based review.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:18:46Z",
  "url": "https://research.draconitic.com/paper/fd025y4apqbd0",
  "venue": "Rheumatology international",
  "versions": []
}