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Dermatomyositis presenting as a paraneoplastic syndrome with resolution of symptoms following surgical management of underlying breast malignancy.

Luu X, Leonard S, Joseph KA - J Surg Case Rep (2015)

Bottom Line: Dermatomyositis (DM) is an uncommon idiopathic inflammatory myopathy that can manifest as a paraneoplastic syndrome of an underlying malignancy.The patient's rash and muscle weakness progressed during the workup of her breast cancer, while she was already started on medical treatment of these symptoms with oral prednisone.Our case report describes the rapid progression and regression of her symptoms emphasizing the benefit of early diagnosis and treatment of DM as well as the underlying breast cancer.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Bellevue Medical Center, New York University School of Medicine, New York, NY, USA.

No MeSH data available.


Related in: MedlinePlus

Image of patient with facial rash and periorbital edema that initially developed during her workup (A). Images of the worsening rash on her chest and hands that initially developed during her workup (B and C).
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RJV075F5: Image of patient with facial rash and periorbital edema that initially developed during her workup (A). Images of the worsening rash on her chest and hands that initially developed during her workup (B and C).

Mentions: Two weeks after the biopsy, she complained of new onset pruritic, erythematous rash on her anterior chest, face and back of the hands (Fig. 5). She also reported slowly worsening periorbital edema (Fig. 5A). She was complaining of diffuse myalgias, worse during menstruation. Owing to her worsening symptoms which included cuticular hypertrophy of the hands with associated erythema over the metacarpophalangeal and proximal interphalangeal joints bilaterally (Fig. 5C), she was transferred to the Bellevue Hospital Breast Clinic and referred to the rheumatology clinic for management of her symptoms. Initial laboratories revealed moderately elevated laboratory values (Table 1). At this time, she was presumptively diagnosed with paraneoplastic DM secondary to invasive ductal carcinoma of the left breast and treated with 20 mg prednisone daily. Her skin manifestations persisted and she subsequently developed upper extremity weakness. Her persistent and slowly progressing symptoms despite aggressive treatments prompted our decision to proceed with surgical intervention in hopes of preventing progression of her musculoskeletal manifestations. The patient underwent an uneventful left lumpectomy with left sentinel lymph node biopsy. Surgical pathology demonstrated a stage 2 poorly differentiated invasive ductal carcinoma (pT2N0). Postoperatively, she experienced rapid improvement in both cutaneous and musculoskeletal manifestations with visible clearing of her rash and return of her strength. There was also a concomitant decline in laboratory values (Table 1). She subsequently underwent adjuvant chemotherapy and radiation therapy. She was maintained on prednisone with excellent symptomatic control. On her 6-month visit, we noted resolution of most of her rash, periorbital edema as well as myalgias and muscle weakness (Fig. 6).Table 1


Dermatomyositis presenting as a paraneoplastic syndrome with resolution of symptoms following surgical management of underlying breast malignancy.

Luu X, Leonard S, Joseph KA - J Surg Case Rep (2015)

Image of patient with facial rash and periorbital edema that initially developed during her workup (A). Images of the worsening rash on her chest and hands that initially developed during her workup (B and C).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
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getmorefigures.php?uid=PMC4495251&req=5

RJV075F5: Image of patient with facial rash and periorbital edema that initially developed during her workup (A). Images of the worsening rash on her chest and hands that initially developed during her workup (B and C).
Mentions: Two weeks after the biopsy, she complained of new onset pruritic, erythematous rash on her anterior chest, face and back of the hands (Fig. 5). She also reported slowly worsening periorbital edema (Fig. 5A). She was complaining of diffuse myalgias, worse during menstruation. Owing to her worsening symptoms which included cuticular hypertrophy of the hands with associated erythema over the metacarpophalangeal and proximal interphalangeal joints bilaterally (Fig. 5C), she was transferred to the Bellevue Hospital Breast Clinic and referred to the rheumatology clinic for management of her symptoms. Initial laboratories revealed moderately elevated laboratory values (Table 1). At this time, she was presumptively diagnosed with paraneoplastic DM secondary to invasive ductal carcinoma of the left breast and treated with 20 mg prednisone daily. Her skin manifestations persisted and she subsequently developed upper extremity weakness. Her persistent and slowly progressing symptoms despite aggressive treatments prompted our decision to proceed with surgical intervention in hopes of preventing progression of her musculoskeletal manifestations. The patient underwent an uneventful left lumpectomy with left sentinel lymph node biopsy. Surgical pathology demonstrated a stage 2 poorly differentiated invasive ductal carcinoma (pT2N0). Postoperatively, she experienced rapid improvement in both cutaneous and musculoskeletal manifestations with visible clearing of her rash and return of her strength. There was also a concomitant decline in laboratory values (Table 1). She subsequently underwent adjuvant chemotherapy and radiation therapy. She was maintained on prednisone with excellent symptomatic control. On her 6-month visit, we noted resolution of most of her rash, periorbital edema as well as myalgias and muscle weakness (Fig. 6).Table 1

Bottom Line: Dermatomyositis (DM) is an uncommon idiopathic inflammatory myopathy that can manifest as a paraneoplastic syndrome of an underlying malignancy.The patient's rash and muscle weakness progressed during the workup of her breast cancer, while she was already started on medical treatment of these symptoms with oral prednisone.Our case report describes the rapid progression and regression of her symptoms emphasizing the benefit of early diagnosis and treatment of DM as well as the underlying breast cancer.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Bellevue Medical Center, New York University School of Medicine, New York, NY, USA.

No MeSH data available.


Related in: MedlinePlus