Successful cure of dermatomyositis after treatment of nonseminomatous testicular cancer

Abstract

Although the association between dermatomyositis and cancer is well recognized, there have been a limited number of reports of dermatomyositis associated with testicular cancer. We report the case of a 31-year-old man who was diagnosed with dermatomyositis. Because the patient's serum levels of a-fetoprotein and human chorionic gonadotropin beta subunit were elevated, the patient was referred to our department. Physical examination revealed an induration (2 cm ¥ 2 cm) in the left testis and the patient was diagnosed with stage IIIB left testicular cancer. A left high orchidectomy was then performed, and pathological examination revealed embryonal carcinoma. The patient was started on a systemic chemotherapeutic (etoposide, ifosfamide and cisplatin; VIP) regimen. After the third chemotherapy session, metastases had completely disappeared, the serum levels of afetoprotein and human chorionic gonadotropin beta subunit had normalized and the dermatomyositis symptoms had improved. Cancer is known to be a trigger of dermatomyositis. This case illustrates the importance of palpation of the testes in young patients with dermatomyositis.

Malignancy in Myositis

“…Isolated case reports have highlighted cancer-associated DM patients in whom the DM improved after successful treatment of the tumor, or worsened with evidence of tumor recurrence [22][23][24]. Such a parallel course between the DM and the malignancy is supportive of a paraneoplastic phenomenon but was observed in only 8 of 45 patients reported by Bonnetblanc et al [24].…”

Cancer and myositis: new insights into an old association

“…Several reports have described cases of marked improvement in myositis signs and symptoms after chemotherapy or resection of an associated tumor [36][37][38], suggesting that a decreased tumor burden mitigates the autoimmune response, possibly through decreasing the autoantigen burden to subthreshold levels. Conversely, myositis that presents shortly before the emergence of a tumor may represent a temporary immunological 'victory' over the nascent malignancy, in an analogous fashion to that observed in the PNDs.…”

Idiopathic Inflammatory Myopathies and Malignancy: a Comprehensive Review

“…The concept that myositis is a paraneoplastic phenomenon is supported by several cases where improvement of the myositis occurred with treatment of the malignancy and worsened with recurrence of the tumor [86][87][88][89][90]. In a case series by Bonnetblanc et al [88], only 18 % (8/45 patients) exhibited a parallel course with malignancy.…”