La dermatomiositis es una miopatía inflamatoria autoinmune, asociada a manifestaciones dermatológicas. Su vinculación con neoplasias está ampliamente reportada, siendo más común en el cáncer pulmonar, especialmente en carcinoma de células pequeñas probablemente por su origen en precursores de células neuroendocrinas, así como también en cáncer de mama y ovario. La baja frecuencia de dermatomiositis dificulta la sospecha de las lesiones subyacentes entre las posibilidades diagnósticas de las enfermedades sistémicas con manifestaciones cutáneas. Por ello siempre se debe considerar la alta probabilidad de una neoplasia, con reportes de hasta 75% en la población oriental y cerca de 40% en general. En este artículo se presenta un caso poco frecuente de dermatomiositis con lesiones de distribución en chal, como debut sintomático de un carcinoma pulmonar de células pequeñas.

Authors: Herman Ahumada Piña[1], Luis Fuentes Cabrera[1], Rodrigo Selamé Glena[1], Daniel García Oneto[1], Andrea Jiménez Aguilar[1,2], Claudia Durán Herrera[1,2], Jorge Ávila Pérez[1,2], Maximiliano Cortés Latorre[1,2]

Affiliation:
[1] Escuela de Medicina, Universidad de Valparaíso, Viña del Mar, Valparaíso, Chile
[2] Servicio de Cirugía, Hospital Dr. Eduardo Pereira, Valparaíso, Chile

E-mail: andita007@gmail.com

Author address:
[1] Hospital Eduardo Pereira
Calle Ibsen sin número esquina Noruega
Valparaíso
Chile

Citation: Ahumada Piña H, Fuentes Cabrera L, Selamé Glena R, García Oneto D, Jiménez Aguilar A, Durán Herrera C, et al. Dermatomyositis as the first manifestation of small cell carcinoma: case report and literature review. Medwave 2016 Nov;16(10):e6609 doi: 10.5867/medwave.2016.10.6609

Submission date: 18/8/2016

Acceptance date: 20/10/2016

Publication date: 15/11/2016

Origin: not requested

Type of review: reviewed by two external peer reviewers, double-blind

PubMed record

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1. Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts). N Engl J Med. 1975 Feb 13;292(7):344-7. | PubMed |
2. Bohan A, Peter JB. Polymyositis and dermatomyositis (second of two parts). N Engl J Med. 1975 Feb 20;292(8):403-7. | PubMed |
3. Paraschiv B, Diaconu CC, Toma CL, Bogdan MA. Paraneoplastic syndromes: the way to an early diagnosis of lung cancer. Pneumologia. 2015;64(2):14-9. | PubMed |
4. Casciola-Rosen L, Nagaraju K, Plotz P, Wang K, Levine S, Gabrielson E, et al. Enhanced autoantigen expression in regenerating muscle cells in idiopathic inflammatory myopathy. J Exp Med. 2005 Feb 21;201(4):591-601. | PubMed |
5. Albert TJ, Bastawrous S, Raugi GJ, Hirschmann JV. A 62-year-old man with skin rash and an abnormal chest radiograph. Chest. 2015 Mar;147(3):e90-4. | CrossRef | PubMed |
6. Pelosof LC, Gerber DE. Paraneoplastic syndromes: an approach to diagnosis and treatment. Mayo Clin Proc. 2010 Sep;85(9):838-54. | CrossRef | PubMed |
7. Sigurgeirsson B, Lindelöf B, Edhag O, Allander E. Risk of cancer in patients with dermatomyositis or polymyositis. A population-based study. N Engl J Med. 1992 Feb 6;326(6):363-7. | PubMed |
8. Stertz G. Polymiositis. BerlKlinWochenschr. 1916;53:489.
9. Kankeleit H. Uber primairenicheitrigepolymiositis. Dtsch Arch Klin Med. 1916;120:335-39.
10. Bernard P, Bonnetblanc JM. Dermatomyositis and malignancy. J Invest Dermatol. 1993 Jan;100(1):128S-132S. | PubMed |
11. Leow YH, Goh CL. Malignancy in adult dermatomyositis. Int J Dermatol. 1997 Dec;36(12):904-7. | PubMed |
12. Di Rollo D, Abeni D, Tracanna M, Capo A, Amerio P. Cancer risk in dermatomyositis: a systematic review of the literature. G Ital Dermatol Venereol. 2014 Oct;149(5):525-37. | PubMed |
13. Airio A, Pukkala E, Isomäki H. Elevated cancer incidence in patients with dermatomyositis: a population based study. J Rheumatol. 1995 Jul;22(7):1300-3. | PubMed |
14. Buchbinder R, Forbes A, Hall S, Dennett X, Giles G. Incidence of malignant disease in biopsy-proven inflammatory myopathy. A population-based cohort study. Ann Intern Med. 2001 Jun 19;134(12):1087-95. | PubMed |
15. Chow WH, Gridley G, Mellemkjaer L, McLaughlin JK, Olsen JH, Fraumeni JF Jr. Cancer risk following polymyositis and dermatomyositis: a nationwide cohort study in Denmark. Cancer Causes Control. 1995 Jan;6(1):9-13. | PubMed |
16. Stockton D, Doherty VR, Brewster DH. Risk of cancer in patients with dermatomyositis or polymyositis, and follow-up implications: a Scottish population-based cohort study. Br J Cancer. 2001 Jul 6;85(1):41-5. | PubMed |
17. Zhang W, Jiang SP, Huang L. Dermatomyositis and malignancy: a retrospective study of 115 cases. Eur Rev Med Pharmacol Sci. 2009 Mar-Apr;13(2):77-80. | PubMed |
18. Dourmishev LA, Popov JM, Rusinova D. Paraneoplastic dermatomyositis associated with testicular cancer: a case report and literature review. Acta Dermatovenerol Alp Pannonica Adriat. 2010;19(1):39-43. | PubMed |
19. Fung WK, Chan HL, Lam WM. Amyopathic dermatomyositis in Hong Kong --association with nasopharyngeal carcinoma. Int J Dermatol. 1998 Sep;37(9):659-63. | PubMed |
20. Selvaag E, Thune P, Austad J. [Dermatomyositis and cancer. A retrospective study]. Tidsskr Nor Laegeforen. 1994 Aug 30;114(20):2378-80. | PubMed |
21. Wang J, Guo G, Chen G, Wu B, Lu L, Bao L. Meta-analysis of the association of dermatomyositis and polymyositis with cancer. Br J Dermatol. 2013 Oct;169(4):838-47. | CrossRef | PubMed |
22. Olazagasti JM, Baez PJ, Wetter DA, Ernste FC. Cancer risk in dermatomyositis: a meta-analysis of cohort studies. Am J Clin Dermatol. 2015 Apr;16(2):89-98. | CrossRef | PubMed |
23. Peng JC, Sheen TS, Hsu MM. Nasopharyngeal carcinoma with dermatomyositis. Analysis of 12 cases. Arch Otolaryngol Head Neck Surg. 1995 Nov;121(11):1298-301. | PubMed |
24. Wong KO. Dermatomyositis: a clinical investigation of twenty-three cases in Hong Kong. Br J Dermatol. 1969 Jul;81(7):544-7. | PubMed |
25. Chao G, Fang L, Lu C, Chen Z. Small cell lung cancer presenting as dermatomyositis: mistaken for single connective tissue disease. Rheumatol Int. 2012 Jun;32(6):1737-40. | CrossRef | PubMed |
26. Lee WY, Kastelik J, Campbell A, Avery G, McGivern D, Lind M. A case report of dermatomyositis associated with small cell lung cancer. Tumori. 2012 Nov;98(6):158e-61e. | CrossRef | PubMed |
27. Azuma K, Yamada H, Ohkubo M, Yamasaki Y, Yamasaki M, Mizushima M, et al. Incidence and predictive factors for malignancies in 136 Japanese patients with dermatomyositis, polymyositis and clinically amyopathic dermatomyositis. Mod Rheumatol. 2011 Apr;21(2):178-83. | CrossRef | PubMed |
28. Chen YJ, Wu CY, Shen JL. Predicting factors of interstitial lung disease in dermatomyositis and polymyositis. Acta Derm Venereol. 2007;87(1):33-8. Erratum in: Acta Derm Venereol. 2007;87(3):286. | PubMed |
29. Ponyi A, Constantin T, Garami M, András C, Tállai B, Váncsa A, et al. Cancer-associated myositis: clinical features and prognostic signs. Ann N Y Acad Sci. 2005 Jun;1051:64-71. | PubMed |
30. Al-Ballaa ST, Al-Dalaan AN, El-Ramahi KM, Al-Janadi MA, Al-Shaikh A, Bahabri S. Pattern of adult onset of polymyositis and dermatomyositis and association with malignancy. Ann Saudi Med. 1993 Nov;13(6):525-9. | PubMed |
31. András C, Ponyi A, Constantin T, Csiki Z, Szekanecz E, Szodoray P, et al. Dermatomyositis and polymyositis associated with malignancy: a 21-year retrospective study. J Rheumatol. 2008 Mar;35(3):438-44. | PubMed |
32. Sparsa A, Liozon E, Herrmann F, Ly K, Lebrun V, Soria P, et al. Routine vs extensive malignancy search for adult dermatomyositis and polymyositis: a study of 40 patients. Arch Dermatol. 2002 Jul;138(7):885-90. | PubMed |
33. Parodi A, Caproni M, Marzano AV, De Simone C, La Placa M, Quaglino P, et al. Dermatomyositis in 132 patients with different clinical subtypes: cutaneous signs, constitutional symptoms and circulating antibodies. Acta Derm Venereol. 2002;82(1):48-51. | PubMed |
34. Duncan AG, Richardson JB, Klein JB, Targoff IN, Woodcock TM, Callen JP. Clinical, serologic, and immunogenetic studies in patients with dermatomyositis. Acta Derm Venereol. 1991;71(4):312-6. | PubMed |
35. Trallero-Araguás E, Rodrigo-Pendás JÁ, Selva-O'Callaghan A, Martínez-Gómez X, Bosch X, Labrador-Horrillo M, et al. Usefulness of anti-p155 autoantibody for diagnosing cancer-associated dermatomyositis: a systematic review and meta-analysis. Arthritis Rheum. 2012 Feb;64(2):523-32. | CrossRef | PubMed |
36. Chinoy H, Fertig N, Oddis CV, Ollier WE, Cooper RG. The diagnostic utility of myositis autoantibody testing for predicting the risk of cancer-associated myositis. Ann Rheum Dis. 2007 Oct;66(10):1345-9. | PubMed |
37. Targoff IN. Myositis specific autoantibodies. Curr Rheumatol Rep. 2006 Jun;8(3):196-203. | PubMed |
38. Spiro SG, Gould MK, Colice GL; American College of Chest Physicians. Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest. 2007 Sep;132(3 Suppl):149S-160S. | PubMed |
39. Krathen MS, Fiorentino D, Werth VP. Dermatomyositis. Curr Dir Autoimmun. 2008;10:313-32. | CrossRef | PubMed |
40. Levine SM. Cancer and myositis: new insights into an old association. Curr Opin Rheumatol. 2006 Nov;18(6):620-4. | PubMed |
41. Soejima M, Kang EH, Gu X, Katsumata Y, Clemens PR, Ascherman DP. Role of innate immunity in a murine model of histidyl-transfer RNA synthetase (Jo-1)-mediated myositis. Arthritis Rheum. 2011 Feb;63(2):479-87. | CrossRef | PubMed |
42. Howard OM, Dong HF, Yang D, Raben N, Nagaraju K, Rosen A, et al. Histidyl-tRNA synthetase and asparaginyl-tRNA synthetase, autoantigens in myositis, activate chemokine receptors on T lymphocytes and immature dendritic cells. J Exp Med. 2002 Sep 16;196(6):781-91. | PubMed |
43. Iorizzo LJ 3rd, Jorizzo JL. The treatment and prognosis of dermatomyositis: an updated review. J Am Acad Dermatol. 2008 Jul;59(1):99-112. | CrossRef | PubMed |
44. Yu KH, Wu YJ, Kuo CF, See LC, Shen YM, Chang HC, et al. Survival analysis of patients with dermatomyositis and polymyositis: analysis of 192 Chinese cases. Clin Rheumatol. 2011 Dec;30(12):1595-601. | CrossRef | PubMed |
45. Shen C, Che G. Dermatomyositis as an antecedent sign of lung cancer in an eldly patient: a case report. J Thorac Dis. 2014 Feb;6(2):E15-8. | CrossRef | PubMed |

Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts). N Engl J Med. 1975 Feb 13;292(7):344-7. | PubMed |

Bohan A, Peter JB. Polymyositis and dermatomyositis (second of two parts). N Engl J Med. 1975 Feb 20;292(8):403-7. | PubMed |

Paraschiv B, Diaconu CC, Toma CL, Bogdan MA. Paraneoplastic syndromes: the way to an early diagnosis of lung cancer. Pneumologia. 2015;64(2):14-9. | PubMed |

Casciola-Rosen L, Nagaraju K, Plotz P, Wang K, Levine S, Gabrielson E, et al. Enhanced autoantigen expression in regenerating muscle cells in idiopathic inflammatory myopathy. J Exp Med. 2005 Feb 21;201(4):591-601. | PubMed |

Albert TJ, Bastawrous S, Raugi GJ, Hirschmann JV. A 62-year-old man with skin rash and an abnormal chest radiograph. Chest. 2015 Mar;147(3):e90-4. | CrossRef | PubMed |

Pelosof LC, Gerber DE. Paraneoplastic syndromes: an approach to diagnosis and treatment. Mayo Clin Proc. 2010 Sep;85(9):838-54. | CrossRef | PubMed |

Sigurgeirsson B, Lindelöf B, Edhag O, Allander E. Risk of cancer in patients with dermatomyositis or polymyositis. A population-based study. N Engl J Med. 1992 Feb 6;326(6):363-7. | PubMed |

Stertz G. Polymiositis. BerlKlinWochenschr. 1916;53:489.

Kankeleit H. Uber primairenicheitrigepolymiositis. Dtsch Arch Klin Med. 1916;120:335-39.

Bernard P, Bonnetblanc JM. Dermatomyositis and malignancy. J Invest Dermatol. 1993 Jan;100(1):128S-132S. | PubMed |

Leow YH, Goh CL. Malignancy in adult dermatomyositis. Int J Dermatol. 1997 Dec;36(12):904-7. | PubMed |

Di Rollo D, Abeni D, Tracanna M, Capo A, Amerio P. Cancer risk in dermatomyositis: a systematic review of the literature. G Ital Dermatol Venereol. 2014 Oct;149(5):525-37. | PubMed |

Airio A, Pukkala E, Isomäki H. Elevated cancer incidence in patients with dermatomyositis: a population based study. J Rheumatol. 1995 Jul;22(7):1300-3. | PubMed |

Buchbinder R, Forbes A, Hall S, Dennett X, Giles G. Incidence of malignant disease in biopsy-proven inflammatory myopathy. A population-based cohort study. Ann Intern Med. 2001 Jun 19;134(12):1087-95. | PubMed |

Chow WH, Gridley G, Mellemkjaer L, McLaughlin JK, Olsen JH, Fraumeni JF Jr. Cancer risk following polymyositis and dermatomyositis: a nationwide cohort study in Denmark. Cancer Causes Control. 1995 Jan;6(1):9-13. | PubMed |

Stockton D, Doherty VR, Brewster DH. Risk of cancer in patients with dermatomyositis or polymyositis, and follow-up implications: a Scottish population-based cohort study. Br J Cancer. 2001 Jul 6;85(1):41-5. | PubMed |

Zhang W, Jiang SP, Huang L. Dermatomyositis and malignancy: a retrospective study of 115 cases. Eur Rev Med Pharmacol Sci. 2009 Mar-Apr;13(2):77-80. | PubMed |

Dourmishev LA, Popov JM, Rusinova D. Paraneoplastic dermatomyositis associated with testicular cancer: a case report and literature review. Acta Dermatovenerol Alp Pannonica Adriat. 2010;19(1):39-43. | PubMed |

Fung WK, Chan HL, Lam WM. Amyopathic dermatomyositis in Hong Kong --association with nasopharyngeal carcinoma. Int J Dermatol. 1998 Sep;37(9):659-63. | PubMed |

Selvaag E, Thune P, Austad J. [Dermatomyositis and cancer. A retrospective study]. Tidsskr Nor Laegeforen. 1994 Aug 30;114(20):2378-80. | PubMed |

Wang J, Guo G, Chen G, Wu B, Lu L, Bao L. Meta-analysis of the association of dermatomyositis and polymyositis with cancer. Br J Dermatol. 2013 Oct;169(4):838-47. | CrossRef | PubMed |

Olazagasti JM, Baez PJ, Wetter DA, Ernste FC. Cancer risk in dermatomyositis: a meta-analysis of cohort studies. Am J Clin Dermatol. 2015 Apr;16(2):89-98. | CrossRef | PubMed |

Peng JC, Sheen TS, Hsu MM. Nasopharyngeal carcinoma with dermatomyositis. Analysis of 12 cases. Arch Otolaryngol Head Neck Surg. 1995 Nov;121(11):1298-301. | PubMed |

Wong KO. Dermatomyositis: a clinical investigation of twenty-three cases in Hong Kong. Br J Dermatol. 1969 Jul;81(7):544-7. | PubMed |

Chao G, Fang L, Lu C, Chen Z. Small cell lung cancer presenting as dermatomyositis: mistaken for single connective tissue disease. Rheumatol Int. 2012 Jun;32(6):1737-40. | CrossRef | PubMed |

Lee WY, Kastelik J, Campbell A, Avery G, McGivern D, Lind M. A case report of dermatomyositis associated with small cell lung cancer. Tumori. 2012 Nov;98(6):158e-61e. | CrossRef | PubMed |

Azuma K, Yamada H, Ohkubo M, Yamasaki Y, Yamasaki M, Mizushima M, et al. Incidence and predictive factors for malignancies in 136 Japanese patients with dermatomyositis, polymyositis and clinically amyopathic dermatomyositis. Mod Rheumatol. 2011 Apr;21(2):178-83. | CrossRef | PubMed |

Chen YJ, Wu CY, Shen JL. Predicting factors of interstitial lung disease in dermatomyositis and polymyositis. Acta Derm Venereol. 2007;87(1):33-8. Erratum in: Acta Derm Venereol. 2007;87(3):286. | PubMed |

Ponyi A, Constantin T, Garami M, András C, Tállai B, Váncsa A, et al. Cancer-associated myositis: clinical features and prognostic signs. Ann N Y Acad Sci. 2005 Jun;1051:64-71. | PubMed |

Al-Ballaa ST, Al-Dalaan AN, El-Ramahi KM, Al-Janadi MA, Al-Shaikh A, Bahabri S. Pattern of adult onset of polymyositis and dermatomyositis and association with malignancy. Ann Saudi Med. 1993 Nov;13(6):525-9. | PubMed |

András C, Ponyi A, Constantin T, Csiki Z, Szekanecz E, Szodoray P, et al. Dermatomyositis and polymyositis associated with malignancy: a 21-year retrospective study. J Rheumatol. 2008 Mar;35(3):438-44. | PubMed |

Sparsa A, Liozon E, Herrmann F, Ly K, Lebrun V, Soria P, et al. Routine vs extensive malignancy search for adult dermatomyositis and polymyositis: a study of 40 patients. Arch Dermatol. 2002 Jul;138(7):885-90. | PubMed |

Parodi A, Caproni M, Marzano AV, De Simone C, La Placa M, Quaglino P, et al. Dermatomyositis in 132 patients with different clinical subtypes: cutaneous signs, constitutional symptoms and circulating antibodies. Acta Derm Venereol. 2002;82(1):48-51. | PubMed |

Duncan AG, Richardson JB, Klein JB, Targoff IN, Woodcock TM, Callen JP. Clinical, serologic, and immunogenetic studies in patients with dermatomyositis. Acta Derm Venereol. 1991;71(4):312-6. | PubMed |

Trallero-Araguás E, Rodrigo-Pendás JÁ, Selva-O'Callaghan A, Martínez-Gómez X, Bosch X, Labrador-Horrillo M, et al. Usefulness of anti-p155 autoantibody for diagnosing cancer-associated dermatomyositis: a systematic review and meta-analysis. Arthritis Rheum. 2012 Feb;64(2):523-32. | CrossRef | PubMed |

Chinoy H, Fertig N, Oddis CV, Ollier WE, Cooper RG. The diagnostic utility of myositis autoantibody testing for predicting the risk of cancer-associated myositis. Ann Rheum Dis. 2007 Oct;66(10):1345-9. | PubMed |

Targoff IN. Myositis specific autoantibodies. Curr Rheumatol Rep. 2006 Jun;8(3):196-203. | PubMed |

Spiro SG, Gould MK, Colice GL; American College of Chest Physicians. Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest. 2007 Sep;132(3 Suppl):149S-160S. | PubMed |

Krathen MS, Fiorentino D, Werth VP. Dermatomyositis. Curr Dir Autoimmun. 2008;10:313-32. | CrossRef | PubMed |

Levine SM. Cancer and myositis: new insights into an old association. Curr Opin Rheumatol. 2006 Nov;18(6):620-4. | PubMed |

Soejima M, Kang EH, Gu X, Katsumata Y, Clemens PR, Ascherman DP. Role of innate immunity in a murine model of histidyl-transfer RNA synthetase (Jo-1)-mediated myositis. Arthritis Rheum. 2011 Feb;63(2):479-87. | CrossRef | PubMed |

Howard OM, Dong HF, Yang D, Raben N, Nagaraju K, Rosen A, et al. Histidyl-tRNA synthetase and asparaginyl-tRNA synthetase, autoantigens in myositis, activate chemokine receptors on T lymphocytes and immature dendritic cells. J Exp Med. 2002 Sep 16;196(6):781-91. | PubMed |

Iorizzo LJ 3rd, Jorizzo JL. The treatment and prognosis of dermatomyositis: an updated review. J Am Acad Dermatol. 2008 Jul;59(1):99-112. | CrossRef | PubMed |

Yu KH, Wu YJ, Kuo CF, See LC, Shen YM, Chang HC, et al. Survival analysis of patients with dermatomyositis and polymyositis: analysis of 192 Chinese cases. Clin Rheumatol. 2011 Dec;30(12):1595-601. | CrossRef | PubMed |

Shen C, Che G. Dermatomyositis as an antecedent sign of lung cancer in an eldly patient: a case report. J Thorac Dis. 2014 Feb;6(2):E15-8. | CrossRef | PubMed |