Amyopathic Dermatomyositis: A Concise Review of Clinical Manifestations and Associated Malignancies.

Abstract

Amyopathic dermatomyositis is a rare, idiopathic, connective tissue disease that presents with dermatologic lesions of classic dermatomyositis but lacks the myopathy of this disease. Cutaneous manifestations may include Gottron's sign, heliotrope rash, and characteristic patterns of poikiloderma. There is a substantial risk for developing interstitial lung disease or malignancy in patients with amyopathic dermatomyositis. A literature review of amyopathic dermatomyositis was performed using the PubMed medical database. The key features of amyopathic dermatomyositis, including autoantibodies, clinical presentation and dermatologic manifestations, epidemiology, history, associated malignancies, management, and pathogenesis, are summarized in this review. Cancer (solid tumor) (73/79, 89%) and hematologic malignancies (9/79, 11%) were reported in 79 patients, with three patients having more than one malignancy. In addition, there were six patients with amyopathic dermatomyositis who had tumor of unknown primary, and eight patients with cancer-associated amyopathic dermatomyositis for whom no additional details were provided. From the group of 73 tumors for whom primary origin and sex were available, malignancy of the genitourinary organs (24/73, 33%), aerorespiratory organs (15/73, 21%), and breast (14/73, 19%) were the most commonly observed solid organ tumors. Tumors of the genitourinary organs (15/48, 31%) and breast (14/48, 29%) were the most frequent neoplasms in women, accounting for 29 of 48 (60%) cancers, with the most common sites being breast (14/48, 29%), ovary (8/48, 17%), and cervix or uterus (5/48, 10%). In men, tumors of the aerorespiratory (9/25, 36%) and genitourinary (9/25, 36%) tracts were the most common neoplasms, accounting for 72% (18/25) of cancers; the most common sites of primary malignancy were nasopharyngeal (6/25, 24%), bladder (4/25, 16%), and either colorectal, lung or prostate cancer (three cancers each, 12%). In summary, the search for an undiagnosed associated malignancy in patients with amyopathic dermatomyositis should focus towards the organs most frequently affected. Similar to classic dermatomyositis, ovarian and nasopharyngeal cancers are also common in amyopathic dermatomyositis. However, in contrast to lung cancer, which is the most frequent malignancy associated with classic dermatomyositis, breast cancer was the most common type of malignancyreported in patients with amyopathic dermatomyosotis.