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Dermatomyositis as a Paraneoplastic Manifestation of Ovarian Cancer: A Case Report and Review of Literature

  • Charu Mahajan
  • Chandrima Ray
  • Ashish SinghalEmail author
  • Bimlesh Thakur
  • Rahat Hadi
  • Pradyuman Singh
Case Report
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Abstract

Dermatomyositis (DM) is a rare autoimmune disease that occurs throughout the world. It is characterized by pathognomonic cutaneous features and symmetrical proximal muscle weakness of striated muscles of limbs, although an amyopathic form of dermatomyositis also exists. The disease is mainly idiopathic but may present as a cutaneous manifestation of cancer. Pathogenesis of DM is poorly understood, but it is believed that it is caused by altered cellular and humoral immunity. Diagnosis is based on a characteristic clinical picture confirmed by biochemistry and biopsy of skin and muscle. Treatment is mainly by steroids, immunosuppressive drugs and management of underlying malignancy. Recurrence of dermatomyositis symptoms is often the first sign of relapse. Prognosis of ovarian cancer in context of dermatomyositis is poor. We hereby report a case of DM who on investigations is diagnosed to have underlying ovarian cancer. She is managed by systemic steroids, chemotherapy and cytoreductive surgery leading to the resolution of disease which again relapsed after 1 year, again preceded by onset of rash and managed by second-line chemotherapy and monoclonal antibody.

Keywords

Dermatomyositis Steroids Rash Muscle 

Notes

Funding

None.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Merali N, Yousuff M, Pronisceva V, Poddar A. Paraneoplastic polymyositis presenting as a clinically occult breast cancer. Ann R Coll Surg Engl. 2017;99(2):e40–e4343.  https://doi.org/10.1308/rcsann.2016.0301.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Sigurgeirsson B, Lindelof B, Edhag O, Allander E. Risk of cancer in patients with dermatomyositis or polymyositis. N Engl J Med. 1992;326:363–7.CrossRefGoogle Scholar
  3. 3.
    Hill C, Zhang Y, Sigurgeirsson B, Pukkala E, Mellemkjaer L, Airio A, Evans S, Felson D. Frequency of specific cancer types in dermatomyositis and polymyositis: a population-based study. Lancet. 2001;357:96–100.CrossRefGoogle Scholar
  4. 4.
    Dobloug GC. Survival and cancer risk in an unselected and complete Norwegian idiopathic inflammatory myopathy cohort. Semin Arthritis Rheum. 2015;45(3):301–8.CrossRefGoogle Scholar
  5. 5.
    Davis MD, Ahmed I. Ovarian malignancy in patients with dermatomyositis and polymyositis: a retrospective analysis of fourteen cases. J Am Acad Dermatol. 1997;37:730–3.CrossRefGoogle Scholar
  6. 6.
    Mammen AL. Dermatomyositis polymyositis and immune mediated necrotizing myopathy. In: Imboden JB, editor. Current diagnosis and treatment: rheumatology, 3rd ed. New York: McGraw Hill; 2013.Google Scholar
  7. 7.
    Uva L, Miguel D, Pinheiro C, Freitas JP, Gomes MM, Filipe P. Cutaneous manifestations of systemic lupus erythematosus. Autoimmune Dis 2012; 2012: Article ID 834291.  https://doi.org/10.1155/2012/834291 CrossRefGoogle Scholar
  8. 8.
    Kissel JT, Mendell JR, Rammohan KW. Microvascular deposition of complement membrane attack complex in dermatomyositis. N Engl J Med. 1986;314(6):329–34.CrossRefGoogle Scholar
  9. 9.
    Callen JP. Dermatomyositis. Lancet. 2000;355:53–7.CrossRefGoogle Scholar
  10. 10.
    Lundberg IE, Miller FW, Tjärnlund A, Bottai M. Diagnosis and classification of idiopathic inflammatory myopathies. J Intern Med. 2016;280(1):39–51.  https://doi.org/10.1111/joim.12524.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Dalakas MC, Hohlfeld R. Polymyositis and dermatomyositis. Lancet. 2003;20(362):971–82.CrossRefGoogle Scholar
  12. 12.
    Rider LG, Shah M, Mamyrova G, Huber AM, Rice MM, Targoff IN, Miller FW, Childhood Myositis Heterogeneity Collaborative Study Group. The myositis autoantibody phenotypes of the juvenile idiopathic inflammatory myopathies. Medicine (Baltimore). 2013;92(4):223–43.  https://doi.org/10.1097/MD.0b013e31829d08f9.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Jakubaszek M, Kwiatkowska B, Maślińska M. Polymyositis and dermatomyositis as a risk of developing cancer. Reumatologia. 2015;53(2):101–5.  https://doi.org/10.5114/reum.2015.51510.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Christie A. Dermatomyositis as presenting feature of ovarian cancer, treated with neo-adjuvant chemotherapy and interval Debulking surgery. Gynecol Oncol Case Rep. 2013;6:13–5.CrossRefGoogle Scholar
  15. 15.
    Smith E, Hallman J, DeLuca A, Goldenberg G, Jorizzo J, Sangueza O. Dermatomyositis: a clinicopathological study of 40 patients. Am J Dermatopathol. 2009;31:61–7.CrossRefGoogle Scholar
  16. 16.
    Barsotti S, Lundberg IE. Current treatment for myositis. Curr Treat Opt Rheumatol. 2018;4(4):299–315.  https://doi.org/10.1007/s40674-018-0106-2.CrossRefGoogle Scholar
  17. 17.
    Callen JP, Hyla JF, Bole GG, Kay DR. The relationship of dermatomyositis and polymyositis to internal malignancy. Arch Dermatol. 1980;116:295–8.  https://doi.org/10.1001/archderm.1980.01640270055013.CrossRefPubMedGoogle Scholar
  18. 18.
    Vermaak E, McHugh N. Current management of dermatomyositis. Int J Clin Rheumatol. 2012;7(2):197–21515.CrossRefGoogle Scholar

Copyright information

© Association of Gynecologic Oncologists of India 2019

Authors and Affiliations

  • Charu Mahajan
    • 1
  • Chandrima Ray
    • 2
  • Ashish Singhal
    • 2
    Email author
  • Bimlesh Thakur
    • 2
  • Rahat Hadi
    • 3
  • Pradyuman Singh
    • 4
  1. 1.Department of GynecologyLucknowIndia
  2. 2.Department of Surgical OncologyLucknowIndia
  3. 3.Department of Radiation OncologyLucknowIndia
  4. 4.Department of PathologyLucknowIndia

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