Anti-transcription intermediary factor 1 gamma (TIF1γ) antibody-positive dermatomyositis associated with ascending colon cancer: a case report and review of the literature

Abstract

Background Anti-transcriptional intermediary factor 1 gamma (TIF1γ) antibody is a marker for predicting cancer association in patients with dermatomyositis (DM). The overall survival rate in DM patients with cancer was reported to be considerably worse than that in DM patients without cancer. However, the treatment for cancer-associated DM remains controversial, because the treatment priority between surgical resection for the tumor and internal treatments, including glucocorticoids, immunosuppressive agents, and intravenous immune globulin, has not been established. Case presentation We report the case of a 57-year-old Japanese man diagnosed with anti-TIF1γ antibody-positive DM associated with ascending colon cancer. His clinical symptoms included facial and brachial edema, muscle weakness, dysphagia, myalgia, and rash. Physical examination revealed periorbital edema and Gottron's papules over his knuckles with brachial edema, and tenderness and weakness of the proximal limb muscles. The findings of hyperintense muscles in T2-weighted sequences of brachial contrast-enhanced magnetic resonance imaging and the infiltration of lymphocytic cells and CD4-positive lymphocytes from muscle biopsy were compatible with the diagnostic criteria for dermatomyositis. Anti-TIF1γ antibody was positive by immunoprecipitation assay. He first started internal treatment including intravenous immunoglobulin, steroid pulse, prednisolone, and azathioprine, followed by surgical resection for the tumor because of the elevation of creatine kinase and progression of dysphagia. However, clinical symptoms did not improve, and the patient died 6 months later. Conclusions We faced difficulties in determining the treatment priority between surgical resection and internal treatment for our case; therefore, this case would be educational for readers. We searched PubMed to identify English-language case reports of anti-TIF1γ antibody-positive dermatomyositis with malignancy and found 21 reported cases. We herein review and summarize previously reported cases of anti-TIF1γ antibody-positive DM with malignancy. Cancer screening is essential in patients with anti-TIF1γ antibody-positive dermatomyositis because it is associated with a high prevalence of malignancies. Our review revealed that initial surgical treatment should be recommended for better prognosis if the general condition allows.

Anti-TIF1γ-Dermatomyositis and Sjögren's Syndrome as Rectal Cancer Inaugural Presentation

“…Hydroxychloroquine is an antimalarial effective in controlling skin diseases in up to 75% of cases. In cancer-associated DM, it is important to treat the cancer to appropriately manage the disease [12]. Our patient improved with both these agents, corticosteroids and hydroxychloroquine, with cutaneous symptoms having resolved after surgery and restart of the treatment.…”

“…In people over 40 years old, there is a great risk of malignancy (4.6-to 6-fold higher than the general population) [9,10]. Management of malignancy-associated DM is difficult to attain, with no guidelines defining the best timing for either cancer-directed surgery or glucocorticoid/immunosuppressive therapy [11,12].…”

Mixed connective tissue and ovarian cancer: a case report

“…Tumour-associated antigens may be produced by inflammatory cells and their production may be increased in rheumatoid arthritis and other autoimmune diseases 14 , 15 , 16 . Transcriptional intermediary factor gamma antibody (TIF1γ), which is considered as precancerous factor 17 .…”

A Case in Which Breast Cancer Developed at the Same Time As Dermatomyositis, and the Onset of New Cancer Was Able to Be Predicted by the Exacerbating Skin Symptoms and Parallel Increase in the Anti-TIF1-γ Antibody Levels

“…Treatment for cancer in previous case reports included surgical resection and chemo-radiotherapy. Ono et al searched PubMed to identify English-language case reports of anti-TIF1-γ antibody-positive DM with malignancy and suggested that the response may change depending on the treatment modality ( 25 ). Regarding the relationship between the initial treatment and outcome, initial surgical treatment led to better outcomes (p=0.0007, Pearson's chi-square test).…”