Diagnosis of Thyroid Neoplasm-Associated Dermatomyositis in Ethiopian Woman

Abstract

Background: Dermatomyositis is an inflammatory myopathies causing proximal muscle weakness accompanied by muscular inflammation and skin rash. Dermatomyositis patients have a higher incidence of malignancy as compared to the general population.

Case report: A 52-year-old known female patient with a toxic multi-nodular goiter presented with insidious onset of itchy erythematous rash on her neck and bilateral hands and progressive muscle weakness of 4 months' duration. Associated with this, she had photosensitivity, and periorbital edema of 2 months' duration. On physical examination, she had an anterior neck mass, proximal muscle weakness, periorbital edema, and violaceous skin rash on her bilateral arms, shoulders and neck. Thyroid function tests were normal, creatinine kinase was elevated, and muscle biopsy revealed inflammatory myositis. Ultrasound of the anterior neck mass and analysis of fine needle aspiration suggested thyroid cancer.

Conclusion: A high index of clinical suspicion is usually required for early diagnosis of dermatomyositis in resource-limited settings in order to prevent adverse outcomes and identify associated malignancies.

Keywords: Ethiopia; Gondar; dermatomyositis; para-neoplastic syndrome; thyroid neoplasm.

Figure 1

Skin manifestation dermatomyositis in thyroid cancer patient at University of Gondar Hospital during admission. (A) skin manifestation on face (heliotrope rash), (B) Gutron’s papule, (C) skin manifestation on hand, (D) V-sign, (E) shawl’s sign, (F) holster sign.

Figure 2

Muscle biopsy of dermatomyositis in thyroid cancer patient at University of Gondar Hospital.

Figure 3

Skin manifestation of dermatomyositis in thyroid cancer patient at University of Gondar Hospital (ffter 2 months of treatment). (A) skin manifestation on face (heliotrope rash), (B) Gutron’s papule, (C) V-sign, (D) holster sign.