Abstract
Dermatomyositis (DM) is a relatively uncommon inflammatory myopathy that has been linked to cancer. We report the case of an 81-year-old woman with cecum adenocarcinoma presenting with antinuclear antibody (ANA) and anti-Mi-2-alpha antibody-positive DM. The patient complained of anorexia, symmetric proximal muscle weakness and skin rash and presented with elevated muscle enzymes. A skin and muscle biopsy supported the diagnosis of DM as did the limbs magnetic resonance imaging (MRI) and electromyography. A diagnosis of localized adenocarcinoma of the cecum was made through colonoscopy and the patient was successfully surgically managed, with decreasing muscle enzymes at discharge and gradual recovery of muscle strength. The presence of both ANA and anti-Mi-2 autoantibodies has classically been described as comprising a better prognosis with a lower risk of underlying malignancy.This case highlights the importance of pursuing a cancer diagnosis in elderly patients presenting with DM even in presence of less predisposing immunological profiles.
Highlights
Dermatomyositis (DM) is a relatively uncommon inflammatory myopathy that has been linked to cancer
We report the case of an 81-year-old woman with cecum adenocarcinoma presenting with antinuclear antibody (ANA) and anti-Mi-2-alpha antibody-positive DM
A skin and muscle biopsy supported the diagnosis of DM as did the limbs magnetic resonance imaging (MRI) and electromyography
Summary
Dermatomyositis (DM) is a relatively uncommon inflammatory myopathy that affects mostly females and can occur at any age [1]. Diagnosis is based on clinical features, laboratory findings - myositis-specific and myositis-associated autoantibodies positivity, elevated serum creatine kinase (CK), lactate dehydrogenase (LDH) and/or transaminases (ALT/AST), and histologic findings on skin and muscle biopsy. This report refers to an elderly patient with colon cancer-associated anti-Mi-2-alpha positive DM, with. An 81-year-old woman was referred to our hospital by her assistant physician due to anorexia, symmetric proximal muscle weakness and erythematous-desquamative skin rash involving the face (malar region, not sparing the nasolabial fold, and eyelids - heliotrope eruption) and extensor surfaces of arms, hands and legs (Gottron’s sign) for the previous month coupled with creatine kinase, myoglobin and transaminases elevation, in blood tests. A discreet improvement of muscle strength (patient able to reach the head with both hands and stand up without help) and descending CK serum levels (1,000U/L at discharge) was noted post-operatively. The patient was advised to promptly seek medical attention if abnormal symptoms presented or known symptoms worsened
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