Heliotrope Rash Precluding Metastatic Ovarian Cancer
Arash Heidari, Maryam Talai-Shahir, Thy Nguyen. Kern Medical Center, Bakersfield, California, United States
Purpose of Study Dermatomyositis is a chronic inflammatory disease of the muscle and skin. The cardinal symptom is a heliotrope rash preceding progressive muscle weakness. The disease is rare, incidence of 0.5–0.89 per 100,000, female to male predominance 2:1. The recognition is challenging but important as there appears to be an association with underlying malignancy as a paraneoplastic phenomenon. Here we report a case of a patient with heliotrope rash with negative surveillance workup for malignancy, however, after 24 months diagnosed with stage IV ovarian cancer.
Methods Used Case report
Summary of Results A 61-year-old Cambodian female presented to emergency department with subjective fever and sharp, non-radiating right eye pain for three days. No associated neuropathies or muscle pain. On examination, patient was afebrile, hemodynamically stable, a circumscribed raised plaquoid lesion noted on right medial eye, erythematous excoriation of upper right eyelid consistent with heliotrope rash. Musculoskeletal and neurological examination was normal. Initial lab work ruled out infectious, immunological, oncological etiology. CT chest/abdomen/pelvis with contrast and colonoscopy completed showed no underlying malignancy. She was prescribed steroid cream, which helped improve the rash to follow-up outpatient but was lost to follow-up until two years later when she presented to emergency department with complain of severe diffuse abdominal pain, intractable nausea/vomiting, and heavy post-menopausal vaginal bleeding. Repeat CT chest/abdomen/pelvis with contrast showed 10cm left ovarian mass. Lab finding significant for elevated CA 125 of 1661U/ml. She underwent surgical resection of tumor. Ultimately diagnosed with stage IV ovarian carcinoma and stage IB1 squamous cell carcinoma of the cervix and initiated chemotherapy
Conclusions Dermatomyositis as a paraneoplastic phenomenon in ovarian cancer has been reported. The diagnosis should be highly suspected based on clinical findings and inconclusive immunological findings. The interval from recognition of dermatomyositis to development of underlying malignancy is variable but often at time of diagnosis or shortly thereafter. Thus patients should receive initial malignancy evaluation and yearly surveillance for malignancy screening to aid in early detection and management
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