Dermatomyositis, hepatocarcinoma, and hepatitis c: Comment on the article by Weidensaul et al

Gómez, A.; Solans, Roser; Simeón, Carmen P.; Selva, Albert; García, Fernando; Fonollosa, Vicencs; Vilardell, M

doi:10.1002/art.1780400232

Cited by 23 publications

(11 citation statements)

References 5 publications

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“…16 However, DM in association with hepatocarcinoma has only been reported in two cases: the present, which had been reported previously, 30 and another one. 31 Finally, paraneoplastic vasculitic syndromes are very rare.…”

Section: Discussionmentioning

confidence: 57%

Clinical significance of antinuclear antibodies in malignant diseases: association with rheumatic and connective tissue paraneoplastic syndromes

Soláns-Laqué

Pérez-Bocanegra

Salud

et al. 2004

Lupus

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Our objective was to determine the prevalence of antinuclear antibodies (ANAs) in patients with malignancies and to investigate if their presence might be related with development of musculoskeletal symptoms or paraneoplastic rheumatic syndromes. Antinuclear antibodies were determined by indirect immunofluorescence on Hep-2 cells in 274 neoplastic patients and in a control group of 140 age-adjusted healthy subjects. Antinuclear antibody specificities (anti-DNA and anti-ENA) were investigated in patients with rheumatological symptoms and positive ANA. Antinuclear antibodies were detected in 76 of 274 (27.7%) patients with malignancies and in nine of 140 (6.4%) healthy subjects. Twenty patients reported paraneoplastic rheumatic symptoms or syndromes. Two of them developed clinical symptoms mimicking rheumatoid arthritis (rheumatoid-like arthropathy), one systemic lupus erythematosus (lupus-like syndrome), one dermatomyositis and four cutaneous vasculitides. Musculoskeletal symptoms and paraneoplastic rheumatic symptoms and syndromes were both more frequently observed in patients with positive ANA. Antinuclear antibody specificities were found in only two cases. We can conclude that there is an increased incidence of antinuclear antibodies in malignant conditions. Musculoskeletal symptoms and rheumatic paraneoplastic symptoms and syndromes seem to be more frequent in patients with cancer-related positive ANAs. The failure to find ANA specificities (anti-ENA, anti-DNA) in patients with malignancies and positive ANAs in our study may simply reflect molecular differences between the autoantigens involved in cancer and those characteristically involved in the systemic autoimmune diseases.

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Section: Discussionmentioning

confidence: 57%

Clinical significance of antinuclear antibodies in malignant diseases: association with rheumatic and connective tissue paraneoplastic syndromes

Soláns-Laqué

Pérez-Bocanegra

Salud

et al. 2004

Lupus

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“…In literature, we can find this association in a case series of five patients by Fiore et al in 1996,5 and in isolated cases reported by Gomez et al in 1997,6 Kee et al in 20047 and Toshikuni et al in 2006 8. In most of the cases of dermatomyositis, the diagnosis of HCV infection was incidental and not always coincident in time.…”

Section: Discussionmentioning

confidence: 79%

Hepatitis C virus infection: ‘beyond the liver’

Castro¹,

Vilas

Borges‐Costa

et al. 2018

BMJ Case Reports

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There are rare reports of association between hepatitis C virus (HCV) infection and dermatomyositis although cause and effect remains to be proven. We present a clinical case with a probable cause and effect association between these two entities. A 71-year-old woman developed an erythematous exanthem with pruritic and scaly lesions located at the torso and upper limbs associated with heliotrope and Gottron's papules. At the same time, she notice a significant loss of muscular strength. Skin and muscular biopsies made the diagnosis of dermatomyositis and the patient started with prednisolone (60 mg/day) with poor symptoms control. Paraneoplastic syndrome, HIV, hepatitis B virus and syphilis infections were excluded. HCV serology was positive, with a viral load of 58 159 IU/mL (genotype 1a). Therefore, the patient underwent a 12-week treatment with grazoprevir 100 mg and elbasvir 50 mg achieving a sustained virological response with regression of skin lesions and complete recovery of muscular strength (photodocumented before/after treatment). Additionally it was possible to reduce prednisolone dosage to 5 mg/day.

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“…Patients died for reasons unrelated to myopathy. 93,94,96 It was not possible to unequivocably determine whether the autoimmune response underlying DM was triggered by the HCV infection or a paraneoplastic phenomenon. Virus-induced autoimmunity seems more likely because HCC-related DM in adults has occurred only in the context of HCV or hepatitis B virus 97,98 infections; in two cases, the viral state was not investigated/recorded.…”

Section: Dermatomyositismentioning

confidence: 98%

“…94 Anti-Jo-1 antibodies were positive in one patient. 93 All patients were treated with oral steroids with variable improvement of muscle strength. Patients died for reasons unrelated to myopathy.…”

Section: Dermatomyositismentioning

confidence: 99%

See 1 more Smart Citation

Neuromuscular Diseases Associated With Chronic Hepatitis C Virus Infection

Stübgen

2011

Journal of Clinical Neuromuscular Disease

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Hepatitis C virus (HCV) infection is a growing international health problem, and more than 170 million people are chronic carriers. Up to 50% of HCV-positive patients develop at least one extrahepatic manifestation during the course of disease. To varying degrees of certainty, there is evidence of an association between chronic HCV infection and a variety of neuromuscular diseases. The pathogenesis of most extrahepatic diseases remains unclear but possibly includes HCV lymphotropism and/or HCV-induced autoantibodies. The therapeutic approach to HCV-associated autoimmune disorders entails eradication of HCV with one of the recombinant interferon-alpha preparations with or without additional immunosuppressive drugs.

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Dermatomyositis, hepatocarcinoma, and hepatitis c: Comment on the article by Weidensaul et al

Cited by 23 publications

References 5 publications

Clinical significance of antinuclear antibodies in malignant diseases: association with rheumatic and connective tissue paraneoplastic syndromes

Clinical significance of antinuclear antibodies in malignant diseases: association with rheumatic and connective tissue paraneoplastic syndromes

Hepatitis C virus infection: ‘beyond the liver’

Neuromuscular Diseases Associated With Chronic Hepatitis C Virus Infection

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