Abstract
The present study reports the case of a 61-year-old male with polymyositis who presented with exacerbated weakness in the lower limbs and a recurrent fever that had persisted for one month. Positron emission tomography/computed tomography scans revealed multiple regions of elevated fluorodeoxyglucose metabolism in the lymph nodes, lungs, liver, spleen and bones. While symptoms of nonchalance and confusion were identified on admission, the patient’s serum calcium level was high at 3.87 mmol/l, so a hypercalcemic crisis was confirmed. A biopsy of the right lingual lymph node revealed peripheral T-cell lymphoma, not otherwise specified. The serum calcium level was restored to within the normal range following emergency measures, such as saline rehydration, diuretics, calcitonin and glucocorticoids, and partial remission was achieved following two courses of chemotherapy. The study may improve our present understanding of the diagnosis and treatment of cancer-associated myositis (CAM) and malignancy-associated hypercalcemia.
Highlights
The present study reports the case of a 61‐year‐old male with polymyositis who presented with exacerbated weakness in the lower limbs and a recurrent fever that had persisted for one month
Hill et al (8) performed a pooled analysis of the populations in Sweden, Denmark and Finland, and revealed a strong association between dermatomyositis and malignancies [standardized incidence ratio (SIR), 3.0; 95% confidence interval (CI), 2.5‐3.6], ovarian (SIR, 10.5; 95% CI, 6.1‐18.1), lung (SIR, 5.9; 95% CI, 3.7‐9.2), pancreatic (SIR, 3.8; 95% CI, 1.6‐9.0), stomach (SIR, 3.5; 95% CI, 1.7‐7.3), and colorectal (SIR, 2.5; 95% CI, 1.4‐4.4) cancer, and non‐Hodgkin's lymphoma (SIR, 3.6; 95% CI, 1.2‐11.1)
Polymyositis was associated with a higher risk of non‐Hodgkin's lymphoma (SIR, 3.7; 95% CI, 1.7‐8.2) and lung (SIR, 2.8; 95% CI, 1.8‐4.4) and bladder (SIR, 2.4; 95% CI, 1.3‐4.7) cancer
Summary
Certain studies based on population have confirmed the association between inflammatory myopathies and malignancies. The value of PET/CT and traditional examinations in polymyositis/dermatomyositis patients have been previously compared (10). Malignancies associated with hypercalcemia in adults include cancers such as lung cancer, head and neck neoplasms, urinary tract neoplasms and breast cancer, and hematological malignancies such as multiple myeloma (incidence rate, 13‐30%), adult T‐cell leukemia/lymphoma (ATLL; 50‐70%), Hodgkin's lymphoma (5%), non‐Hodgkin's lymphoma (0.8‐13%) and acute myeloid leukemia (extremely rare) (4). The final diagnosis in the present study was of peripheral T‐cell lymphoma with hypercalcemic crisis as a primary symptom accompanied by polymyositis; to the best of our knowledge, such a case has not previously been reported. Polymyositis/dermatomyositis are strongly associated with malignancies, physicians should screen for tumors in patients with inflammatory myopathies to avoid missing the diagnosis, within five years of the onset of the disease.
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