Occurrence of Dermatomyositis Immediately after Mastectomy Subsequent to Severe Chemotherapeutic Drug Eruption

Abstract

We herein report a patient with breast cancer who developed dermatomyositis (DM) immediately after mastectomy. She had a history of severe drug eruption during neoadjuvant chemotherapy six months previously. Within a month after the operation, myalgia and rash, including Gottron's papules, developed, and skeletal-muscle enzymes elevated, so she was diagnosed with probable DM according to the Bohan and Peter criteria. In many neoplastic DM cases, the course of the disease parallels the course of the malignancy. Possible mechanisms were suggested to explain the development of DM in the present case and offer new insight into autoimmune diseases.

Acute worsening of dermatomyositis after initiation of PARP inhibitor therapy in two women with advanced ovarian malignancy

“…This finding has not been previously described in the literature with PARP inhibitors but has been described with other chemotherapeutic agents, particularly with DM ( Chen et al, 2014 , Manson et al, 2019 , Yoshino et al, 2013 , Otsuka et al, 2017 ). It is unclear why DM is particularly prone to this phenomena, but ovarian cancer has one of the strongest associations with DM and providers should have a high suspicion when patients present with rash, fatigue, muscle weakness and myalgias, especially soon after initiating treatment in these patients ( Yang et al, 2015 ).…”

“…These findings are suggestive of an indirect relationship between Olaparib and their acute DM presentation. We hypothesize that they both had preexisting dermatomyositis which was acutely exacerbated by a large volume of antigen cross reactivity similar to a “tumor lysis like syndrome” ( Chen et al, 2014 , Manson et al, 2019 , Yoshino et al, 2013 , Otsuka et al, 2017 ). A similar phenomenon has been described in patients with a wide range of cancers treated with PD-1 or PD-L1 immunotherapies as well as in cancers treated with traditional chemotherapeutic agents such as carboplatin/etoposide or 5-Fluorouracil.…”

“…Case reports and series have described the acute worsening of paraneoplastic syndromes, especially DM, after the initiation of treatment for the underlying malignancy ( Chen et al, 2014 , Manson et al, 2019 , Yoshino et al, 2013 , Otsuka et al, 2017 ). The initiating factor in these cases is complicated by certain medications having been known to trigger or worsen DM ( Chen et al, 2014 ).…”

“…In other cases, the worsening of DM severity appeared to be independent of chemotherapy administration after the initial period. The proposed mechanism was exposure of a large volume of antigen in the tumor cells leading to worsening autoimmunity, possibly in the manner similar to a “tumor lysis syndrome” ( Manson et al, 2019 , Yoshino et al, 2013 , Otsuka et al, 2017 ).…”

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

“…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.…”