Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Apr 1;12(4):e7498.
doi: 10.7759/cureus.7498.

'Shawl Sign' as a Paraneoplastic Dermatosis

Eukesh Ranjit  1 , Amit Sapra  1 , Airn Etherton  1 , Waiz Wasey  2 , Priyanka Bhandari  1
Affiliations
Case Reports

'Shawl Sign' as a Paraneoplastic Dermatosis

Eukesh Ranjit et al. Cureus. .

Abstract

Dermatomyositis (DM) is an idiopathic condition characterized by inflammation of muscles and skin lesions. It is often a paraneoplastic manifestation of internal malignancy. Hence, early recognition of this disorder is important. Although not all dermatomyositis are associated with malignancies, the ones with such association regress with the treatment of associated malignancy. In clinical practice, symptoms of muscle weakness can be vague, and skin lesions can be dismissed as sunburn. We present a case of an elder adult female who presented with dermatomyositis as a paraneoplastic syndrome secondary to an underlying Mullerian malignancy.

Keywords: atypical presentation; atypical rash; dermatomyositis; malignancy; metastatic disease; paraneoplastic syndrome; shawl sign; skin biopsy; skin rash; sunburn.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. CT scan of the abdomen and pelvis with contrast showing hepatic lesions concerning for metastatic disease.
Figure 2
Figure 2. Positron emission tomography (PET) scan showing diffuse hepatic metastatic disease.
Figure 3
Figure 3. Red, maculopapular well-demarcated rash on the chest wall ‘Shawl sign’.
Figure 4
Figure 4. Picture of the rash over the patient’s upper back showing also the biopsy site (blue circle).
Figure 5
Figure 5. Skin biopsy showing vacuolar interface dermatitis, a classic skin biopsy finding in dermatomyositis.
Figure 6
Figure 6. Liver biopsy showing the tumor cells positive for cytokeratin 7 immunostaining.
Figure 7
Figure 7. Hematoxylin and Eosin stain of the liver biopsy showing poorly differentiated cells suggestive of malignancy.
See this image and copyright information in PMC

References

    1. Paraneoplastic syndromes: an approach to diagnosis and treatment. Pelosof LC, Gerber DE. Mayo Clin Proc. 2010;85:838–854. - PMC - PubMed
    1. The clinical features, diagnosis and classification of dermatomyositis. Iaccarino L, Ghirardello A, Bettio S, Zen M, Gatto M, Punzi L, Doria A. J Autoimmun. 2014;48-49:122–127. - PubMed
    1. Polymyositis and dermatomyositis. Bohan A, Peter JB. N Engl J Med. 1975;292:403–407. - PubMed
    1. Factors associated with underlying malignancy in a retrospective cohort of 121 patients with dermatomyositis. Fardet L, Dupuy A, Gain M, et al. Medicine. 2009;88:91–97. - PubMed
    1. Cancer risks of dermatomyositis and polymyositis: a nationwide cohort study in Taiwan. Chen YJ, Wu CY, Huang YL, Wang CB, Shen JL, Chang YT. Arthritis Res Ther. 2010;12:70. - PMC - PubMed

Publication types

LinkOut - more resources