Dermatomyositis as an extrahepatic manifestation of hepatitis B virus-related hepatocellular carcinoma: A case report and literature review

Abstract

Rationale: Dermatomyositis is an idiopathic inflammatory myopathy with specific cutaneous manifestations, which is closely associated with malignancy. However, the exact mechanism remains elusive. Even less is known about dermatomyositis with hepatocellular carcinoma (HCC).

Patient concerns: We reported a case of dermatomyositis with hepatitis B virus (HBV) infection. He incidentally found his lower limbs little weakness accompanied with his wrist erythema. He was found HBsAg positive for forty years with slightly positive of α-fetal protein (AFP).

Diagnoses: A dermapathology from his hand-wrist lesions demonstrated a scattered inflammatory infiltrate around the capillaries of the dermis. Abdominal enhanced computer tomography (CT) revealed infiltrative HCC affecting the whole liver, accompanied by liver metastasis and liver cirrhosis. Liver tumor needle biopsy pathology showed HCC with moderate differentiation. The left supraclavicular lymph node needle biopsy pathology confirmed metastasic HCC.

Interventions: Prednisolone was gradually withdrawn with the introduction of Entecavir 0.5 mg daily. Radiofrequency ablation therapy for liver tumor was performed once in order to decrease the tumor load.

Outcomes: His muscle power improved to grade 4+/5 in the lower limb one month after anti-HBV treatment. However, this patient died finally from liver failure due to the development of liver tumor.

Lessons: In the coming clinic work, we must pay more attention to the extrahepatic disorder induced by HBV. On treating experience, glucocorticoid administration is often contraindicated for HBV infected patients because of its potential promotion of HBV replication. Thus, it is necessary to administrate high-effective anti-HBV drug prior to glucocorticoid treatment in order to prevent liver failure.

Figure 1

Clinical manifestation of dermatomyositis in this patient. (A) Extinctive heliotrope rash over his wrists. (B) Poikiloderma on the back neck.

Figure 2

Both dermis and muscle tissues armed with HE staining (×200). (A) Showed a scattered inflammatory infiltrate around the capillaries of the dermis on hand wrist. (B) Indicated no abnormal symbol in the quadriceps femoris muscle.

Figure 3

Both lymph node and liver tumor tissues armed with HE staining (×200) as well as radiological findings of HCC. (A) Revealed HCC metastasis in the left supraclavicular lymph nodes. (B) Showed HCC in liver. HCC = hepatocellular carcinoma.

Figure 4

CK spectrum post-medical treatment of anti-HBV treatment. CK = creatine kinase, LDH = lactate dehydrogenase.