Breast Cancer Associated with Dermatomyositis

Dermatomyositis (DM) is a rare idiopathic inflammatory myopathy with characteristic skin lesions. Case series have shown an association between dermatomyositis and malignancy. Malignancy has been found in 15-25% of the adult patients with dermatomyositis. A 50-year-old new case of breast cancer, was admitted with muscle weakness and inability to walk. Physical examination revealed fever, periorbital edema, a heliotrope rash on the upper eyelids, a large right-sided breast mass and erythematous plaques on the upper chest, abdomen and legs. During hospitalization, she developed a nasal speech, dysphasia, and nasal regurgitation of food and water. A clinical diagnosis of dermatomyositis secondary to breast adenocarcinoma was made according to the skin lesions, muscle weakness, elevated ESR, and increased CPK and LDH levels. Wide spectrum antibiotics and Dexamethasone were administered but fever persisted. Although chemotherapy was recommended, she developed respiratory failure and aspiration pneumonia and died. Dermatomyositis is one of the paraneoplastic syndromes which are associated with breast cancer. Although treatment of dermatomyositis generally includes corticosteroids with or without immunosuppressants, cancerdirected specific therapy including surgery and/or chemotherapy would be more effective. Dermatomyositis should be considered in breast cancer patients with skin lesions and muscle weakness and cancer-specific therapy should be started as soon as possible.