Paraneoplastic dermatomyositis in hepatocellular carcinoma with colonic perforation: A case report

Naoteru Miyata, Katsura Emoto, Yoshiaki Dei, Kazuhiro Tomiyasu, Ryoko Ishiyama, Tomofumi Horie, Gen Sakai, Toshiyuki Tahara

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Dermatomyositis (DM) is an autoimmune disease characterized by cutaneous Gottron papules, heliotrope rash, and proximal myopathy. It may also present as a paraneoplastic syndrome that can complicate a variety of different cancers, such as lung, cervical, and breast cancer. However, the association with hepatocellular carcinoma (HCC) is extremely rare. Moreover, to our knowledge, there are no previous reports of colonic perforation following steroid pulse treatment for a DM patient. Case Summary: A 61-year-old male complained of a skin rash that began in his neck and spread to his face and abdomen. On physical examination, the patient was also found to have symmetrical proximal muscle weakness, abdominal pain, heliotrope rash in the periorbital skin, and poikiloderma on his face and abdomen. Serum level of muscle enzymes was remarkably increased. Muscle examination revealed symmetrical proximal weakness. The diagnosis of DM was made, and steroid treatment was started for symptomatic relief. A search for causative malignancy revealed HCC. Despite steroid therapy for DM, his symptoms did not improve. Additionally, C-reactive protein elevation was seen along with severe abdominal pain on day 14 of admission. Shortly after this, the patient died of septic shock due to suppurative peritonitis after perforation of the ascending colon. Conclusion: Here, we present a rare case of DM caused by non-hepatitis-associated advanced HCC with colonic perforation. The cause of colonic perforation is still unclear. This case demonstrates the need to carefully monitor abdominal pain in DM patients as symptoms can be masked by steroid therapy.

Original languageEnglish
Pages (from-to)547-553
Number of pages7
JournalCase Reports in Oncology
Volume9
Issue number3
DOIs
Publication statusPublished - 2016 Sep 13
Externally publishedYes

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Dermatomyositis
Hepatocellular Carcinoma
Exanthema
Steroids
Abdominal Pain
Abdomen
Paraneoplastic Syndromes
Ascending Colon
Muscles
Skin
Muscle Weakness
Muscular Diseases
Therapeutics
Septic Shock
Peritonitis
Uterine Cervical Neoplasms
C-Reactive Protein
Autoimmune Diseases
Physical Examination
Lung Neoplasms

Keywords

  • Case report
  • Colonic perforation
  • Dermatomyositis
  • Hepatocellular carcinoma

ASJC Scopus subject areas

  • Oncology

Cite this

Paraneoplastic dermatomyositis in hepatocellular carcinoma with colonic perforation : A case report. / Miyata, Naoteru; Emoto, Katsura; Dei, Yoshiaki; Tomiyasu, Kazuhiro; Ishiyama, Ryoko; Horie, Tomofumi; Sakai, Gen; Tahara, Toshiyuki.

In: Case Reports in Oncology, Vol. 9, No. 3, 13.09.2016, p. 547-553.

Research output: Contribution to journalArticle

Miyata, N, Emoto, K, Dei, Y, Tomiyasu, K, Ishiyama, R, Horie, T, Sakai, G & Tahara, T 2016, 'Paraneoplastic dermatomyositis in hepatocellular carcinoma with colonic perforation: A case report', Case Reports in Oncology, vol. 9, no. 3, pp. 547-553. https://doi.org/10.1159/000449370
Miyata, Naoteru ; Emoto, Katsura ; Dei, Yoshiaki ; Tomiyasu, Kazuhiro ; Ishiyama, Ryoko ; Horie, Tomofumi ; Sakai, Gen ; Tahara, Toshiyuki. / Paraneoplastic dermatomyositis in hepatocellular carcinoma with colonic perforation : A case report. In: Case Reports in Oncology. 2016 ; Vol. 9, No. 3. pp. 547-553.
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