Letter to the Editor

Abstract

Paraneoplastic dermatomyositis associated with bladder cancerSir-Dermatomyositis (DM) is an uncommon inflammatory myopathy of unknown aetiology characterized by pain and weakness in the proximal muscles, cutaneous symptoms (Gottron's sign and heliotrope erythema) and compatible electrophysiological and pathological findings. DM is related to an increased risk of cancer (~three-fold with respect to the expected number of cancer cases without DM), often considered as a paraneoplastic syndrome. 1 The malignancies most strongly associated with DM are ovarian, lung, gastrointestinal cancers and non-Hodgkin's lymphoma. 1 However, the association with the bladder cancer (BC) is unusual. A PUBMED search (key words: dermatomyositis, bladder cancer, bladder tumour, bladder neoplasm, bladder carcinoma, transitional cell carcinoma) revealed only 17 cases in which DM was associated with BC. 1-14 We report here a case of DM as the first manifestation of the recurrence of a BC.We describe the case of a 79-year old man with a medical history of hypertension and chronic obstructive pulmonary disease, type 2 diabetes mellitus and dyslipemia. He had a long history of cigarette smoking until two years before being diagnosed with transitional cell carcinoma of the bladder (Grade I). He underwent transurethral resection of the tumour and received intravesical immunotherapy. After one year of follow-up, a programmed transurethral cystoscopy resulted normal. Eight months later, that is, four months previous to DM manifestation, he underwent a routine digital rectal examination and a mild enlargement of the prostate was found, which was confirmed by a urologic sonography. At this time, no lesions in the bladder were observed. Likewise, he denied symptoms of prostatism. Serum total prostatespecific antigen level was 4.8 ng/mL (normal Ͻ6.5 ng/mL). Urine sediment analysis resulted negative for malignancy and haematuria. On the basis of these findings, he received a diagnosis of benign prostatic hyperplasia. The patient remained asymptomatic until that he began to present an erythematosus, inflammatory, desquamative rash affecting his face, forehead, scalp, upper torso and forearms. A periorbital purplish erythema consistent with heliotrope rash and liquenoid papules overlying his metacarpophalangeal joints also appeared. Finally, he developed sub-acute pain and weakness in the proximal muscles of the upper and lower extremities, dysphagia and dysphonia. He denied abdominal pain, burning on urination, gross haematuria, anorexia or a significant weight loss. Laboratory tests revealed: creatine phosphokinase 2227 UI/L, lactate dehydrogenase 636 UI/L, white blood cells count 9.0 ϫ 10 9 /L (77% of neutrophils), hemoglobin 12.6 g/dL, platelet count 139 ϫ 10 9 /L, erythrocyte sedimentation rate 23 mm/hour, C-reactive protein 5 mg/dL. Urinalysis showed microscopic haematuria. Immunological tests (including antinuclear antibodies, anti-double-stranded DNA antibodies, anti-Sm, antiRo/SSA, anti-La/SSB, anti-RNP, anti-Jo 1 and complement levels), serum...

Recurrent dermatomyositis manifesting as a sign of recurrent transitional cell carcinoma of urinary bladder: Long-term survival

“…[2] Where DM is associated with underlying malignancy, tumor therapy may lead to resolution of DM. [2] Interestingly, a reverse relationship also exists, whereby a flare of DM occurs with tumor recurrence,[345] an association that is demonstrated in this report.…”

“…[6] Despite this, paraneoplastic DM secondary to bladder TCC has been observed very rarely. [2345678910] A literature search of the PubMed database (MeSH terms: Urinary bladder neoplasms, transitional cell carcinoma, dermatomyositis) revealed only 12 published reports documenting an association between DM and TCC of the bladder. The recurrence of DM as a first sign of metastatic TCC is extremely rare.…”

“…[5] Furthermore, relapses of DM following tumor therapy are often an indicator of tumor recurrence or progression and warrant reinvestigation. [345] With TCC of the bladder, relapses of DM have been found to occur mainly with local recurrence of tumors;[34] however, there also appears to be one reported case associated with the development of metastatic disease. [5] This isolated case, described by Federman et al , was a 68-year-old man who redeveloped symptoms of DM 1 year after successful therapy for bladder TCC; he was found to have developed liver metastases.…”

A Rare Case Seen in a Patient with Intravesical Bacillus Calmette-Guerin (BCG) Intolerance: Autoimmune Myopathy

“…Dermatomyositis cases have been reported after BCG vaccination (10). In addition, a few cases of dermatomyositis have been reported in patients with bladder tumors (11).…”

An Unusual Paraneoplastic Syndrome of Synchronous Bladder Tumor and Prostate Cancer: Polymyositis

“…Polymyositis (PM) is an idiopathic uncommon inflammatory myopathy characterized by pain and weakness in the proximal muscles, compatible electrophysiological and pathological findings [1]. If cutaneous symptoms like Gottron's sign and heliotrope erythema exist, we diagnose it as Dermatomyositis (DM).…”