J Rheum Dis.  2014 Oct;21(5):261-265. 10.4078/jrd.2014.21.5.261.

Dermatomyositis Associated with Gallbladder Cancer

• Park JS
• Pyo JY
• Park YB
• Lee SK
• Lee SW

• KMID: 2222951
• DOI: http://doi.org/10.4078/jrd.2014.21.5.261

Abstract

Dermatomyositis, an idiopathic inflammatory myopathy with characteristic skin manifestations, is associated with several types of cancer. Only three cases of gallbladder cancer with dermatomyositis have been reported worldwide, and none has been reported in Korea. We present a case of a 71-year-old male with proven dermatomyositis associated with gallbladder cancer to emphasize the necessity of work-up for malignancies with low incidence in patients with inflammatory myopathies.

Keyword

Dermatomyositis; Gallbladder cancer; Malignancy; Inflammatory myopathy

MeSH Terms

Aged
Dermatomyositis*
Gallbladder Neoplasms*
Humans
Incidence
Korea
Male
Myositis
Skin Manifestations

Figure

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  Figure 1. (A) Gottron's papules on the right hand. (B) Heliotrope rash and a forehead erythematous patch. (C) V sign, Shawl sign, and erythematous patches on both shoulders and the left anterior chest wall.

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  Figure 2. PET/CT scan. Diffuse and mild fluorodeoxyglucose uptake in skeletal muscle was seen (black arrow), which likely indicates inflammatory changes due to dermatomyositis involvement. Fluorodeoxyglucose uptake in the disrupted gallbladder wall (white arrow) and pericholecystic fat infiltration in the gallbladder body were seen.

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  Figure 3. Biliary dynamic CT scan. (A) Irregular wall thickening of the gallbladder with pericholecystic fat infiltration and GB cancer with serosa invasion (T3). (B) Enlarged lymph nodes were seen at the cystic duct, portahepatis, portocaval, and bilateral para-aortic space, which are suggestive of metastatic lymph nodes.

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  Figure 4. Changes in muscle enzyme levels. (A) aspartate aminotransferase (AST, normal range: 13.0∼34.0 IU/L), (B) creatine phosphokinase (CK, normal range: 44∼245 IU/L); day 1: admission, day 7: beginning administration of low-dose prednisolone, day 14-day 49: concurrent chemoradiotherapy, day 75: CT imaging after concurrent chemoradiotherapy, day 90: planned chemotherapy, long arrow: administration of prednisolone, short arrows: 5-FU administration.

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