Dermatomyositis with anti-TIF-1γ antibodies as a presenting symptom of underlying triple-negative breast cancer: a case report

Abstract

BackgroundDermatomyositis is an autoimmune myopathy characterized by proximal muscle weakness, muscle inflammation, and typical skin findings. It is a rare disease with an incidence of ~1/100 000. About 15–30 % of adult-onset cases are caused by underlying malignancy and dermatomyositis can be the first symptom of undiagnosed cancer, mainly in the case of anti-transcription intermediary factor 1γ (anti-TIF-1γ) antibodies presence. TIF-1γ is a transcriptional cofactor which is implicated in TGFβ signaling pathway that controls cell proliferation, differentiation, apoptosis, and tumorigenesis. Its expression was shown to be associated with younger age, higher tumor grade, more estrogen receptor negativity, tumors larger than 2 cm, and tendency towards poor outcome in early breast cancer. No association between anti-TIF-1γ antibodies and prognosis has been proposed yet.Case presentationWe report a case of a 43-year-old premenopausal woman presenting with the symptoms of systemic rheumatic disease, the most prominent being a typical skin rash and muscle pain. After a series of investigations, the patient was diagnosed with anti-TIF-1γ positive dermatomyositis and concurrent triple-negative breast cancer (cT1c N3c M0) as an underlying cause. Immediate intravenous corticosteroid therapy relieved the symptoms and enabled anticancer therapy to be commenced. Considering the tumor stage, neoadjuvant therapy with 4 courses of AC (Doxorubicin/Cyclophosphamide) followed by 4 courses of Paclitaxel/Carboplatin was administered. However, no tumor regression was documented and radiotherapy was chosen as the definitive treatment.ConclusionEarly detection of anti-TIF-1γ autoantibodies can contribute to a rapid diagnosis of tumor-associated dermatomyositis and enable immediate anticancer treatment. We demonstrate the emerging role of anti-TIF-1γ antibodies in the diagnostics of tumor-associated dermatomyositis. Furthermore, we propose a potential role of anti-TIF-1γ antibodies as a prognostic marker in early breast cancer patients.

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

“…In patients with severe disease, steroid pulse of intravenous mPSL 1000 mg for three consecutive days is also an option for treatment. In addition, the introduction of IVIG or immunosuppressive medications such as methotrexate, azathioprine, cyclophosphamide, or ciclosporin is another option if the patient does not respond to steroid therapy or suffers adverse side effects [ 9 , 29 ]. Although these internal treatments are essential for the control of DM, the risk of surgical treatment will increase due to the immunocompromised effect.…”

“…In fact, patients with early-stage disease could firstly undergo surgery according to the cancer stage in Table 1 . Conversely, the patients with initial internal treatment include unresectable cancers, in which surgical resection itself is not applicable at the point of diagnosis [ 9 , 13 , 20 , 22 , 24 , 26 ]. Table 2 (c) shows the relationship between the maximum creatine kinase level and outcome.…”

A Case of Pathological Complete Response and Resolution of Dermatomyositis Following Neoadjuvant Chemotherapy in HER2-Positive Early Breast Cancer

“…It has been observed that the presence of specific myositis-related autoantibodies (MSA) is associated with different clinical manifestations. The finding of high levels of anti-TF1γ and anti-NXP2 is frequent in paraneoplastic forms (about 80%) and often these patients have severe skin manifestations and dysphagia; a recent meta-analysis showed that patients with high levels of anti-TF1γ have a 27-fold higher odds ratio of developing malignancy [3,4].…”

“…Currently, there are no guidelines or randomized trials for the management of breast cancer complicated by dermatomyositis. The literature is based exclusively on case reports [1,2,4,6,8,[11][12][13][14][15][16][17][18][19]. The existing reports do not clearly indicate whether an immediate or postponed surgical approach to neoadjuvant therapy is preferable.…”

MRI of myositis and other urgent muscle-related disorders

“…While a rare disease, with an incidence of approximately 1/100,000, adult-onset dermatomyositis is associated with a concomitant malignancy in 15-30% [34]. Paraneoplastic polymyositis may herald a yet undiagnosed malignancy or coincide with a tumor diagnosis.…”