An otherwise healthy 63-year-old woman presented with a 3-month history of weight loss, malaise, and abdominal pain as first symptoms, followed by back pain, proximal muscle weakness, and symmetrical painful decapacitating arthritis of the small joints of the hands. On physical examination, reddish-brown papules and nodules were found on the dorsum of the fingers, some overlying the periungual area (Fig 1). A photo-distributed pink, violaceous erythema with telangiectasias was noticeable on the neck and anterior chest (Fig 2). Ovarian cancer was found during the follow-up period. Punch biopsy of a nodule was performed (Figs 3 and 4).
Herein, an otherwise healthy 63-year-old Caucasian woman with a three month-history of progressive symmetrical swelling and of the fingers, lumbal and abdominal pain, proximal muscle weakness, and heliotropic rash resembling V- neck, histologically verified as multicentric reticulohistiocytosis (MRH), is presented. Multiple computer tomography scans failed to detect ovarian cancer despite elevated Ca 125, however, it was verified six months later by magnetic resonance investigation. Multicentric reticulohistocytosis (MRH) is a rare systematic disease that targets skin, mucoses and synovium, resulting in skin nodules, mucosal lesions and deforming painful mutilating polyarthritis. Twenty – five percent of all patients are associated with internal malignancies, hence, MRH paraneoplastic nature remains extremely controversial. Our case showed a peculiar dermatomyositis-like clinical subtype, which we consider suggestive for verification of an underlying malignancy.
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