Paraneoplastic dermatomyositis associated with testicular malignancy

Paraneoplastic dermatomyositis associated with testicular malignancyA 25-year-old Taiwanese male came to our dermatologic clinic due to muscle weakness, facial erythema, and peri-orbital swelling for 3 weeks (Figure 1A).He was diagnosed with testicular embryonal carcinoma with lung metastasis (Figure 1E,F) and had just received orchiectomy 2 weeks prior to cutaneous manifestations.Upon physical examination, Gottron's papules (Figure 1C) were seen along with trunk erythema.Skin biopsy in right dorsal hand showed hyperkeratosis, acanthosis, and papillary dermal edema with mucin deposition in the dermis (Figure 1G, H).Direct immunofluorescence revealed scattered ovoid bodies over the dermal-epidermal junction.Laboratory exam showed increased levels of CPK (2663 IU/L), LDH (293 IU/L), and alpha-fetoprotein (34.83 ng/mL).Dermatomyositis (DM) was impressed.Prednisolone with 30 mg per day was given initially, but the symptoms persisted.After administered first chemotherapy with bleomycin, etoposide, and cisplatin (BEP) for testicular cancer, his symptoms and skin erythema significantly improved (Figure 1B,D) along with declined level of CPK and tumor markers.Auto-antibody of anti-transcription intermediary factor 1-gamma (TIF1-γ) showed positive result (1+), and therefore, paraneoplastic DM related to