INTRODUCTION: The inflammatory myopathies are a group of acquired diseases characterized by a proximal myopathy due to skeletal muscle inflammation. Myositis association with malignancy has been well described, particularly in dermatomyositis (DM).Although dysphagia may be the presenting symptoms for DM given striated muscles at upper esophagus;it has also been associated with increased risk of malignancy.Cancer-associated myositis (CAM) is thought to be a cross-reaction to regenerating muscle tissue as seen in tumor antigen. An estimated 20-30% of DM patients will develop cancer. CASE DESCRIPTION/METHODS: Case of a 70-year-old male who arrived to the emergency department due to three-week history of progressive dysphagia with a 45-pound weight loss in the past 3 months. Also reported skin rash and generalized weakness. Physical examination with lower proximal limb weakness and generalized erythematous patches more prominent over the trunk with scaly violaceous raised papules in the knuckles and in the interphalangeal joints. Laboratories showed elevated muscle enzymes including aldolase, creatinine kinase, transaminases and lactate dehydrogenase.Negative myositis specific antibodies including ANTI-JO1, ANTI-MI2 and ANTI-SRP. MRI showed inflammatory muscle disease. Gastroenterology proceed with esophagogastroduodenoscopy for evaluation of dysphagia with findings of a nodular lesion inside a hiatal hernia. Biopsies were consistent with adenocarcinoma with positive stains for HER2 and AE1/AE3 suggesting advance poorly differentiated adenocarcinoma. Metastatic workup with evidence of retroperitoneal adenopathy. Hematology Oncology started chemotherapy with FOLFOX-6 and radiotherapy. He showed some initial improvement; however, later he succumbed to respiratory tract infection. DISCUSSION: In this case, the patient was found with an underlying esophageal malignancy along with DM which are findings consistent with CAM. The absence of myositis specific antibodies supports the diagnosis. Dysphagia can be the presenting symptom of both DM and esophageal cancer. In DM is due to the involvement of the oropharyngeal striated muscles and upper esophagus.In the setting of an underlying inflammatory myopathy symptoms can be misleading, causing misdiagnosis. It is important that all patients diagnosed with a myopathy along with alarming symptoms undergo evaluation for the possibility of an underlying malignancy since prognosis and life expectancy in CM patients is determined by the underlying malignant disease.