Dermatomyositis associated with gastrointestinal malignancies – report of two cases and a literature review

Dermatomyositis is an idiopathic inflammatory myopathy with specific cutaneous lesions that are probably due to an autoimmune reaction. The exact pathogenesis is not fully understood, but drugs, infectious agents, or underlying malignancies may be the cause of dermatomyositis. The first report of dermatomyositis related to malignancy was published in 1916 [1]. Since that time the association between dermatomyositis and cancer has been extensively studied. It is difficult to determine whether malignancies contribute to the development of dermatomyositis or whether dermatomyositis contributes to the development of cancer. Some studies have reported a 3- to 6-fold higher risk of malignancy in patients with dermatomyositis [2]. Skin and muscle symptoms may precede the clinical diagnosis of cancer, appear simultaneously, or only after the detection of the tumour. However, they most frequently occur during the first year after the initial cancer diagnosis [3, 4].
We present 2 cases of dermatomyositis, diagnosed according to the Bohan and Peter criteria, that were associated with cancer and developed shortly after diagnosis.
A 73-year-old female patient with a history of hypertension and hypercholesterolaemia presented with extensive skin lesions and weakness of the upper body part muscles for 1 month. There was no known family history of skin diseases, and no history of infection, trauma, drug use, or toxic exposure. Physical examination revealed redness of the face, neck and shoulders, Gottron’s papules over the joints of the hands, and ecchymosis and telangiectasias in the nail shafts of the fingers (Figures 1 A, B). Complete blood count, urinalysis, and other routine laboratory tests returned normal, except elevated serum transaminases: alanine aminotransferase (ALT) 60 U/l (reference range: 10–49 U/l), aspartate aminotransferase (AST) 116 U/l (reference range: 8–34 U/l), creatinine phosphokinase (CK) 2062 U/l (reference range: 29–168 U/l), and lactate dehydrogenase (LDH) 388 U/l (reference range: 120–246 U/l). Autoantibody screening revealed positive antinuclear antibodies (ANA) with a titre 1 : 320 of homogenous pattern, and no specific ANA was found. The skin and muscle biopsy showed nonspecific inflammatory changes (Figure 2 C), while electromyography (EMG) revealed myogenic muscle damage. A diagnosis of dermatomyositis based on the clinical and laboratory features was made; glucocorticoids treatment was started (prednisolone 0.6 mg/kg/day),...


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