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CORRESPONDENCE
Year : 2014  |  Volume : 59  |  Issue : 6  |  Page : 615-616
Paraneoplastic dermatomyositis associated with gallbladder carcinoma: A case report and mini-review of the published work


Department of Dermatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Japan

Date of Web Publication30-Oct-2014

Correspondence Address:
Noriaki Nakai
Department of Dermatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.143543

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How to cite this article:
Sawada T, Nakai N, Masuda K, Katoh N. Paraneoplastic dermatomyositis associated with gallbladder carcinoma: A case report and mini-review of the published work. Indian J Dermatol 2014;59:615-6

How to cite this URL:
Sawada T, Nakai N, Masuda K, Katoh N. Paraneoplastic dermatomyositis associated with gallbladder carcinoma: A case report and mini-review of the published work. Indian J Dermatol [serial online] 2014 [cited 2019 May 22];59:615-6. Available from: http://www.e-ijd.org/text.asp?2014/59/6/615/143543


Sir,

Paraneoplastic dermatomyositis (PDM) associated with gallbladder carcinoma (GBC) is extremely rare. We report a case of PDM associated with GBC and describe the clinical characteristics based on a review of English-language published work. [1],[2],[3],[4]

A 90-year-old Japanese woman was referred to our department for inpatient hospital care for eruptions and progressive muscle weakness that had been present for 1 month and 10 days, respectively. Clinical examination showed characteristic dermatomyositis (DM) eruption with heliotrope rash, erythema keratodes, and Gottron's papules [Figure 1]a and b. Histopathology of the erythema was consistent with DM [Figure 1]c. Abnormal laboratory examination included liver and biliary tract dysfunctions (aspartate aminotransferase, 474 U/L; normal range, 12-35; alanine aminotransferase, 195 U/L; normal range, 6-33; gamma-glutamyl transpeptidase, 98 U/L; normal range, 3-54) and elevated serum C-reactive protein (2.75 mg/dl; normal range, 0-0.2) and creatine kinase (CK) (7811 U/L; normal range, 36-177 U/L) levels. Autoantibody screening was positive for antinuclear antibody (titer, 1:80; normal, <1:40) and negative for anti-Jo-1 antibody. Serum tumor markers, including carcinoembryonic antigen and carbohydrate antigen-125, were negative. Electromyography showed a myogenic pattern. Interstitial pneumonia was not seen on computed tomography, but the result was consistent with liver and paraaortic lymph node metastases from GBC [Figure 1]d. PDM associated with GBC was diagnosed. There were no indications for surgery or chemotherapy because she had advanced GBC and was advanced in age. Oral administration of prednisolone 50 mg/day, topical application of 0.1% tacrolimus hydrate on the face and 0.05% difluprednate on the extremities, and muscle functional rehabilitation treatment were started. The eruptions faded in 14 days [Figure 1]e and f and serum CK levels reached normal limits. The prednisone dose was decreased gradually to 35 mg/day. However, the muscle weakness progressed. She was transferred to a palliative care hospital because of further progression of her cancer.
Figure 1: Clinical findings (a, b) at fi rst visit and (e, f) after treatment, (c) histopathological study, and (d) computed tomography scan. (a, b) Edematous erythemas on the forehead and eyelids, and erythema keratodes on the knee were seen. (c) Histopathology of the erythema on the right knee showed a liquefaction degeneration of the basal cell layer and a mild perivascular lymphocytic infi ltrate in the superfi cial dermis. (d) Computed tomography showed a swollen gallbladder, thickening of the gallbladder wall, multiple space occupying lesions of the liver, and paraaortic lymph node swelling. (e, f) The eruptions faded in 14 days

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There have been five patients with PDM associated with GBC. [1],[2],[3],[4] All of these patients were female and the age range was 44-90 years. In all evaluable cases, heliotrope rash and Gottron's papules were seen. In four of five patients, elevated CK levels and positive antinuclear antibody test results were seen. In all evaluable patients, negative anti-Jo-1 antibody test results were seen. One patient showed elevated levels of tumor markers, suggesting that the markers might not have diagnostic reliability. Two patients received surgery for GBC. Three patients received systemic administration of steroids for the treatment of PDM. In all evaluable patients, the eruptions improved while muscle weakness improved in two patients, suggesting that skin response to treatment was better than muscle response. Only one patient is alive with no evidence of cancer recurrence or skin eruption.

This is the first review report of PDM associated with GBC. In our case, the entire eruption regressed, but muscle weakness did not improve. The results may be associated with an underlying malignancy and/or progressive disuse syndrome. The case also illustrates the importance of medical practitioners making efforts to improve the quality of life of patients with poor prognosis.

 
   References Top

1.Yiannopoulos G, Ravazoula P, Meimaris N, Stavropoulos M, Andonopoulos AP. Dermatomyositis in a patient with adenocarcinoma of the gall bladder. Ann Rheum Dis 2002;61:663-4.  Back to cited text no. 1
    
2.Kundu AK, Karmakar PS, Bera AB, Pal SK. Carcinoma of the gall bladder presenting as dermatomyositis. J Assoc Physicians India 2005;53:219-22.  Back to cited text no. 2
    
3.Narasimhaiah DA, Premkumar JA, Moses V, Chacko G. Carcinoma of gall bladder presenting as dermatomyositis. Ann Indian Acad Neurol 2011;14:44-6.  Back to cited text no. 3
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4.Ni QF, Liu GQ, Pu LY, Kong LL, Kong LB. Dermatomyositis associated with gallbladder carcinoma: A case report. World J Hepatol 2013;5: 230-3.  Back to cited text no. 4
    


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