Exacerbation of Dermatomyositis with Recurrence of Rectal Cancer: A Case Report

Abstract

Dermatomyositis (DM) is a rare idiopathic inflammatory myopathy characterized by cutaneous and muscle manifestations. The association between DM and malignancy has been well recognized for many years. The clinical course of paraneoplastic DM may be affected by malignancies, although the cause and effect relationship between exacerbation of DM and cancer progression is uncertain. Herein, we report a 44-year-old woman who presented with progressive DM associated with rectal cancer. After curative resection of rectal cancer, DM symptoms resolved. Three months after surgery, blood test surveillance showed elevation of serum carcinoembryonic antigen levels, although the patient remained asymptomatic. One month later she had a DM flare-up, and multiple lung and liver metastases were found. She immediately underwent cancer chemotherapy with prednisolone therapy for DM. However, her condition deteriorated and she was unable to swallow. Percutaneous endoscopic gastrostomy was constructed, allowing alimentation and oral delivery, which made it possible to keep her on chemotherapy. She had remarkable response for unresectable metastases 8 weeks after the administration of chemotherapy. Seven months after onset of recurrence, her condition improved considerably and she had stable disease. Moreover, she can now eat food of soft consistency. Our case provides further support for the clinical importance of cancer chemotherapy for patients who have progressive DM and unresectable rectal cancer.

The Impact of Dysphagia in Myositis: A Systematic Review and Meta-Analysis

“…This effect is also described for dysphagia [ 44 ]. Both tumor resection [ 180 , 181 , 182 ] and chemotherapy [ 182 , 183 , 184 ] can improve or relieve impaired deglutition.…”

Paraneoplastic dermatomyositis associated with metastatic leiomyosarcoma of unknown primary

“…The severity of the skin lesions appeared to wax and wane, with the metastatic disease suggesting a temporal relationship between cutaneous features and leiomyosarcoma disease status. In patients with paraneoplastic dermatomyositis and advanced cancer, similar temporal relationships have been described [ 31 , 32 ]. The development of erythema in the ‘V’ neck distribution, in hindsight, may have been the first early sign of dermatomyositis and mild progression of metastatic disease.…”

Successful resection of liver metastasis detected by exacerbation of skin symptom in a patient with dermatomyositis accompanied by rectal cancer: a case report and literature review

“…Patients with DM and malignant disease have reportedly a worse prognosis than patients with idiopathic DM; surgical resection was not possible in many of the patients with cancer because of the advanced stage of their disease [10]. Difficulties in the management of cancer chemotherapy and medication for DM symptoms have also been reported due to severe dysphagia in patients with unresectable metastases [6]. Successful treatment of these malignancies can lead to resolution of paraneoplastic symptoms.…”

“…A literature search was conducted in April 2016 using the PubMed and Ichushi database to obtain English and Japanese literature describing recurring cases of patients with colorectal cancer and DM; four reports were found [6, 12–14]. The keywords used in the search were “dermatomyositis” and “colorectal cancer.” The details of clinicopathological features of these cases, including the present case, are demonstrated in Table 1.…”

“…Malignancies are usually diagnosed within a year from the onset of myopathy, and the extent of DM symptoms has been associated with the progression of metastatic diseases [5]. Recent reports have demonstrated the relationship between the exacerbation of DM symptoms and cancer recurrence [6]. …”