From the Rheumatology Unit, Internal Medicine Department (Alghanim), and from the Internal Medicine Department (Gasmelseed), King Fahad Medical Military Complex, Dhahran, Kingdom of Saudi Arabia.
Saudi Med J. 2021 May;42(5):570-573. doi: 10.15537/smj.2021.42.5.20200583.
We report a case involving a 73-year-old Saudi man diagnosed with dermatomyositis who subsequently developed Kaposi's sarcoma one month later. He had difficulty in rising from a chair and increased leg weakness while climbing stairs or walking. He was unable to comb his hair and had greater dysphagia with liquids than with solid foods. Laboratory tests showed elevated liver enzyme and creatine kinase levels. Right quadriceps muscle biopsy indicated inflammatory myopathy, which was consistent with adult dermatomyositis. We administered 1-g/day methylprednisolone intravenously for 3 days, followed by 60-mg oral prednisolone daily, which led to significant improvements in his muscle strength and dysphagia symptoms. The creatine phosphokinase level normalized. Computed tomography and endoscopic examinations did not reveal any evidence of an underlying malignancy. The patient was discharged and underwent close monitoring at a rheumatology clinic. We subsequently added 50-mg oral azathioprine daily to the treatment regimen. At one month after emergency room presentation, multiple new dusky violaceous macules and plaques appeared on his chest, face, upper back, neck, and upper limbs. A biopsy of one of these lesions showed findings consistent withKaposi's sarcoma. He was referred to an oncology center for chemotherapy, following which his skin lesions significantly regressed. Dermatomyositis may be considered a paraneoplastic syndrome of Kaposi's sarcoma.
我们报告了一例 73 岁沙特男性患者，该患者被诊断患有皮肌炎，一个月后随后发展为卡波西肉瘤。他从椅子上站起来困难，爬楼梯或行走时腿部无力加重。他无法梳头，吞咽液体比固体食物更困难。实验室检查显示肝酶和肌酸激酶水平升高。右股四头肌活检提示炎症性肌病，符合成人皮肌炎。我们给予 1g/天静脉注射甲基强的松龙 3 天，随后给予 60mg 口服泼尼松龙，这导致他的肌肉力量和吞咽困难症状显著改善。肌酸磷酸激酶水平正常化。计算机断层扫描和内镜检查均未发现任何潜在恶性肿瘤的证据。患者出院，并在风湿病诊所接受密切监测。我们随后在治疗方案中添加了 50mg 口服硫唑嘌呤。在急诊就诊一个月后，他的胸部、面部、上背部、颈部和上肢出现多个新的暗紫红色斑疹和斑块。其中一个病变的活检显示符合卡波西肉瘤的发现。他被转介到肿瘤中心进行化疗，随后他的皮肤病变明显消退。皮肌炎可能被认为是卡波西肉瘤的副肿瘤综合征。
