Abstract
BackgroundAdenocarcinoma of the pancreas only rarely is associated with inflammatory myopathy. In this setting, polymyositis may be treated with glucocorticoids in combination with cancer specific treatment.Case presentationWe present the case of a 52-year-old man with stage IIA pancreatic tail adenocarcinoma who underwent surgical treatment and six months into therapy with gemcitabine he developed symmetrical, painful, proximal muscle weakness with peripheral oedema. Re-evaluation with imaging modalities, muscle histology and biochemistry conferred the diagnosis of polymyositis associated with pancreatic cancer progression. The patient was treated with glucocorticoids along with gemcitabine and erlotinib which resulted in complete remission within six months. He remained in good health for a further six months on erlotinib maintenance therapy when a new computer tomography scan showed pancreatic cancer relapse and hence prompted 2nd line chemotherapy with gemcitabine.ConclusionsPolymyositis associated with pancreatic cancer may respond to glucocorticoids along with cancer specific treatment.
Highlights
Adenocarcinoma of the pancreas only rarely is associated with inflammatory myopathy
Polymyositis associated with pancreatic cancer may respond to glucocorticoids along with cancer specific treatment
Sigurgeirsson et al[2] further sustained that inflammatory myopathy is strongly associated with malignancy and the malignant diseases most associated with inflammatory myositis were, in descending order: lung cancer, rectum and colon cancer, pancreatic cancer, kidney cancer, stomach cancer, breast cancer and Carpenter et al[3] reported poor prognosis when significant weakness is experienced at presentation
Summary
Pancreatic adenocarcinoma is the fourth leading cause of cancer death, with an overall 5-year survival rate of less than 10% [1] and the incidence appears to be increasing. We present a case of polymyositis complicating the physical history of a patient with pancreatic adenocarcinoma on treatment with gemcitabine who responded well to glucocorticoids along with cancer specific treatment. There was thickening of the fibrous connective tissue septa and foci of fat infiltration; all the above findings were suggestive of myositis (Figure 1). Erlotinib 100 mg daily was started on standard gemcitabine based chemotherapy Following his discharge, treatment with methylprednisolone 16 mg daily on tapering dose was continued for six months along with gemcitabine and erlotinib with complete remission of polymyositis. Chemotherapy was ceased along with corticosteroids and the patient remained on treatment with maintenance erlotinib remaining in good health and leading an Figure 1 Histological findings of muscle biopsy. Twelve months following his discharge a repeat CT scan showed pancreatic cancer relapse and prompted 2nd line chemotherapy with gemcitabine. The progressive malignant disease was not followed by a myositis relapse
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
