Ultrastructural features can be very useful in diagnosis of IIMs: Tubuloreticular inclusions (TRIs) in endothelial cells are an early sign of dermatomyositis (66) and most DM biopsies irrespective of the associated autoantibody, show TRIs, with the exception of anti-MDA5 DM which shows TRIs in only 50% (60). The gene discussed is PRDM10; the disease is dermatomyositis.