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  Table of Contents  
Year : 2015  |  Volume : 52  |  Issue : 4  |  Page : 713-714

Rash: Aninitial presentation of ovarian cancer

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 Publication10-Mar-2016

Correspondence Address:
S Amer
Department of Internal Medicine, Brookdale University Hospital and Medical Center Brooklyn, New York - 11212
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-509X.178441

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How to cite this article:
Amer S, Qureshi W, Hassan S. Rash: Aninitial presentation of ovarian cancer. Indian J Cancer 2015;52:713-4

How to cite this URL:
Amer S, Qureshi W, Hassan S. Rash: Aninitial presentation of ovarian cancer. Indian J Cancer [serial online] 2015 [cited 2020 Jul 14];52:713-4. Available from:


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.
Figure 3: Sagittal section of ovarian cancer

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Figure 4: Axial section of ovarian cancer

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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.[1],[2],[3],[4] Concomitant presence of dermatomyositis and malignancy indicates poor prognosis.[5]

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.

  References Top

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;326:363-7.  Back to cited text no. 1
Levine SM. Cancer and myositis: New insights into an old association. Curr Opin Rheumatol 2006;18:620-4.  Back to cited text no. 2
Chen YJ, Wu CY, Huang YL, Wang CB, Shen JL, Chang YT. Cancer risks of dermatomyositis and polymyositis: A nationwide cohort study in Taiwan. Arthritis Res Ther 2010;12:R70.  Back to cited text no. 3
So MW, Koo BS, Kim YG, Lee CK, Yoo B. Idiopathic inflammatory myopathy associated with malignancy: A retrospective cohort of 151 Korean patients with dermatomyositis and polymyositis. J Rheumatol 2011;38:2432-5.  Back to cited text no. 4
Torres C, Belmonte R, Carmona L, Gómez-Reino FJ, Galindo M, Ramos B, et al. Survival, mortality and causes of death in inflammatory myopathies. Autoimmunity 2006;39:205-15.  Back to cited text no. 5


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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