Fatal case of clinically amyopathic dermatomyositis: Cotton‐wool spots as a sign of an aggressive subtype of dermatomyositis

Dear Editor, Clinically amyopathic dermatomyositis (CADM) is sometimes complicated by rapidly progressive interstitial lung disease (RP-ILD) and poor prognosis. We present a fatal case of CADM with cotton-wool spots (soft exudates) in eye fundi. A 64-year-old woman was admitted in August 2012 with skin ulcers on her elbows, knees, right shoulder, buttocks and left dorsal foot (Fig. 1a–c). A malignant phyllodes tumor in her right breast had been removed in 2009. Physical examination revealed heliotrope rash, periungual erythema, mechanic’s