Case Report

Dermatomyositis and Esophageal Cancer

Authors: Imran Iftikhar, MD, Dima Abdelmannan, MD, MRCP, Hamed A. Daw, MD

Abstract

Objective: A case of dermatomyositis and esophageal cancer is described.


Case Report: A 58-year-old male recently diagnosed with esophageal cancer was admitted to the hospital with complaints of progressive dysphagia, generalized muscle weakness and skin rash. The weakness started symmetrically in the proximal limb muscles. He also developed a characteristic skin rash on the eyelids, the upper chest and around the nails that was thought to be most indicative of dermatomyositis. Creatine kinase, aspartate aminotransferase and aldolase were elevated. A muscle biopsy showed various degrees of degeneration with perivascular interstitial infiltration of lymphoplasma cells, a finding consistent with “dermatomyositis.” The patient was started on corticosteroids and within two weeks, his muscle strength was found to be markedly improved and the rash almost disappeared.


Conclusion: Dysphagia can be the presenting symptom of both dermatomyositis and esophageal cancer. In the setting of an underlying malignancy, these symptoms can be misleading and one can miss the diagnosis of dermatomyositis. However, recognition of the characteristic skin rash may provide a clue to the diagnosis. Another aspect of our case that is worth acknowledgment is the quick response to treatment with corticosteroids.


Key Points


* The incidence of dermatomyositis and esophageal cancer is rare.


* It is important to differentiate dysphagia due to a malignancy from dermatomyositis.


* The mainstay of treatment remains corticosteroids and with early recognition and initiation of treatment, a faster response can be expected.

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