Department of Rheumatology, Geisinger Medical Center, Danville, Pennsylvania 17822, USA.
Am J Clin Dermatol. 2010;11(2):151-5. doi: 10.2165/11530170-000000000-00000.
A 37-year-old Caucasian woman was evaluated for a photosensitive dermatitis. A positive anti-nuclear antibody with a titer of 1 : 1280 and a speckled pattern was noted and she was diagnosed with subacute cutaneous lupus erythematosus (SCLE). Although the initial dermatologic diagnosis was SCLE, a skin biopsy suggested the additional possibility of dermatomyositis because of increased dermal mucin. We began following her at the request of the dermatology department, and a diagnosis of amyopathic dermatomyositis was made based on the lack of objective muscle weakness, normal muscle enzymes, negative double-stranded DNA, SSA/SSB, and RNP/Smith antibody panel, and especially on the cutaneous examination findings. A malignancy evaluation included a normal CT scan of her chest, abdomen, and pelvis, esophagogastroduodenoscopy, colonoscopy, mammography, pelvic ultrasound, Papanicolaou smear, and endometrial biopsy. She developed vaginal bleeding 1 year after the onset of her skin manifestations. Repeat gynecologic evaluation, including cervical biopsy, revealed a large B-cell cervical lymphoma. Amyopathic dermatomyositis and lymphoma of the cervix are both rare conditions. Our case emphasizes the importance of considering underlying malignancy at the time of diagnosis and while the patient is followed clinically. Additionally, the clinician must remain vigilant in evaluating any new clinical changes in follow-up care. To our knowledge, this is the first documented case of lymphoma of the cervix in the setting of amyopathic dermatomyositis.
一位 37 岁的白种女性因光敏性皮炎就诊。检测到阳性抗核抗体，滴度为 1:1280，呈斑点型，被诊断为亚急性皮肤型红斑狼疮（SCLE）。尽管最初的皮肤科诊断为 SCLE，但皮肤活检提示可能还存在皮肌炎，因为真皮中存在更多粘蛋白。皮肤科要求我们对她进行随访，由于缺乏客观的肌肉无力、正常的肌肉酶、双链 DNA、SSA/SSB 和 RNP/Smith 抗体谱阴性，以及皮肤检查结果，我们做出了无肌病性皮肌炎的诊断。癌症评估包括胸部、腹部和骨盆的 CT 扫描、上消化道内镜、结肠镜检查、乳房 X 光检查、盆腔超声、巴氏涂片和子宫内膜活检均正常。在皮肤表现出现 1 年后，她出现了阴道出血。重复妇科评估，包括宫颈活检，发现了大 B 细胞宫颈淋巴瘤。无肌病性皮肌炎和宫颈淋巴瘤均为罕见疾病。我们的病例强调了在诊断时和临床随访期间考虑潜在恶性肿瘤的重要性。此外，临床医生在随访护理中必须时刻警惕评估任何新的临床变化。据我们所知，这是首例无肌病性皮肌炎伴发宫颈淋巴瘤的病例。
