J Breast Cancer.  2015 Jun;18(2):195-199. 10.4048/jbc.2015.18.2.195.

Dermatomyositis and Paclitaxel-Induced Cutaneous Drug Eruption Associated with Metastatic Breast Cancer

• Kim Y
• Jung W
• Park YH

• KMID: 2374536
• DOI: http://doi.org/10.4048/jbc.2015.18.2.195

Abstract

Dermatomyositis (DM) is an idiopathic autoimmune connective disease characterized by muscles and skin inflammation of and a well-recognized association with several human malignancies, especially breast cancer. Paclitaxel is a taxane antineoplastic agent with therapeutic effects against a wide range of cancers including breast cancer. This drug is well known for neurotoxicity and hypersensitivity reactions. However, cutaneous drug eruptions, especially those of grade III or higher, are not frequent. Here, we describe the case of a 55-year-old woman with metastatic breast cancer who developed paraneoplastic DM and a paclitaxel-induced exanthematous drug eruption. This case report emphasizes the importance of evaluating internal malignancies, such as advanced breast cancer, in newly developed DM patients. In addition, it presents a rare case of paclitaxel-induced exanthematous drug eruption. The purpose of this case report highlights the immunological pathogenic mechanism of DM and drug eruption in underlying advanced breast cancer.

Keyword

Breast neoplasms; Dermatomyositis; Drug eruptions; Immunity; Paclitaxel

MeSH Terms

Breast Neoplasms*
Dermatomyositis*
Drug Eruptions*
Female
Humans
Hypersensitivity
Inflammation
Middle Aged
Muscles
Paclitaxel
Skin
Paclitaxel

Figure

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  Figure 1 A diagnostic core needle biopsy for carcinoma in the left breast. (A) H&E stain revealed invasive ductal (×200). (B) HER2/neu expression was positive by immunohistochemistry (×200).

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  Figure 2 Radiologic findings for chest computed tomography (CT). CT scan shows the primary breast cancer of the left breast (A) and multiple lymphadenopathies of the left axilla (B), mediastinum (C, D), right axilla (E), and paratrachea (F). Arrows indicate enlarged lymph nodes and mass.

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  Figure 3 Microscopic findings for skin biopsy. (A) Perivascular and interstitial lymphocytic infiltration with small, dark nuclei and scant cytoplasm, are compatible with dermatomyositis (H&E stain, ×400). (B) Aggregates of mature lymphocytes are seen surrounding vessels (H&E stain, ×200).

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  Figure 4 Gross findings for paclitaxel induced drug eruption. (A) A skin lesion presented as generalized exanthematous rashes on the trunk (upper) and extremities (lower) 9 days after the first exposure to paclitaxel. (B) A skin lesion became milder 5 minutes after the second exposure to paclitaxel.

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