|LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 4 | Page : 713-714
Rash: Aninitial presentation of ovarian cancer
S Amer1, W Qureshi2, S Hassan2
1 Department of Internal Medicine, Brookdale University Hospital and Medical Center Brooklyn, New York - 11212, U.S.A
2 Deparment of Internal Medicine, Henry Ford Hospital, Detroit, Michigan 48202, U.S.A
|Date of Web Publication||10-Mar-2016|
Department of Internal Medicine, Brookdale University Hospital and Medical Center Brooklyn, New York - 11212
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Amer S, Qureshi W, Hassan S. Rash: Aninitial presentation of ovarian cancer. Indian J Cancer 2015;52:713-4
A 49-year-old female presented with an erythematous rash that started on the upper arms and later spread to her face, chest, and shoulders. It was associated with pruritus and fatigue. She also had a papular rash present on the extensor surfaces of bilateral digits [Figure 1]. She was initially diagnosed with non-specific dermatitis and treated for it. However, the rash worsened and she also developed mild muscular weakness. Labs showed Creatine phosphokinase (CPK) levels of 646 initially and which later rose to 1794. She was negative for hepatitis B surface antigen, hepatitis C antibody, Antinuclear antiboby (ANA), Sjogren's syndrome A/Sjogren's syndrome B anti SSA/SSB antibodies. Myoadenylate deaminase (MAD), CO, Nicotinamide dinucleotide phosphate (NADH) staining showed normal pattern. Muscle biopsy was positive for Major Histocompatibility Complex-1 (MHC I), cluster of differentiation CD20, CD3, and CD 68, signifying inflammation of muscles. Due to the skin changes characteristic of shawl sign [Figure 2] (diffuse, flat erythematous lesion occurring in a V-shaped distribution over the anterior neck and chest) and erythroderma, along with proximal muscle weakness and elevated CPK, a diagnosis of dermatomyositis was made and prednisone was started.
|Figure 1: Roughening and cracking of the skin of the fingers, resulting in irregular, dirty-appearing lines that resemble those of a manual laborer. “Mechanic hands”|
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|Figure 2: Shawl sign (V-shaped distribution over the anterior neck and chest) and erythroderma on the face|
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Although, prednisone caused creatine phosphokinase (CPK) to decrease to 1040 and there was mild improvement in rash, the muscle weakness continued to worsen over the next month to the point, where she was unable to dress herself. Examination, at this time showed normal reflexes in the upper and lower extremities. Normal sensations to pin prick, monofilament, proprioception and light touch were found. Electromyography (EMG) showed moderate to severe myopathic process. Despite being on high-dose steroids for 2 months, she started losing weight. At this time, occult malignancy was suspected. She was screened with a mammogram and a Pap smear More Details, which turned out to be normal.
Computerized Tomograph of CT abdomen [Figure 3] and [Figure 4] revealed a heterogeneous mass within the left adnexa, with cystic and solid components. A panel of tumor markers showed elevated Cancer antigen 125 (CA 125), Carcinoembryonic antigen 2.6 (CEA 2.6). It was followed by whole body CT, which showed left ovarian carcinoma with retroperitoneal adenopathy and peritoneal carcinomatosis. Subsequently, total abdominal hysterectomy with bilateral salpingo-oophorectomy was carried out. It was followed by chemotherapy with taxol and carboplatin. However, despite aggressive treatment she soon developed malignant pleural effusion and ascites. Eventually, she was transferred to hospice and died shortly thereafter.
The present case is rare because, dermatomyositic rash was the initial presentation of ovarian cancer. Dermatomyositis (DM) has been associated with malignancies of the ovaries, brteast, uterus, lung, pancreas, stomach, and the nasopharynx.,,, Concomitant presence of dermatomyositis and malignancy indicates poor prognosis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]