Dermatomyositis Associated with Docetaxel Use in the Treatment for Ovarian Cancer

A 50-year-old woman presented with a 1-week history of rash on the face and hands and difficulty when rising from a sitting position. She underwent an exploratory laparotomy for ovarian cancer 8 months ago. Three months ago, she underwent total hysterectomy, adnexectomy, and retroperitoneal lymph node dissection. Docetaxel and carboplatin were started and administered twice. Physical examination revealed periorbital edema with a purplish appearance; Erythematous lesions on radiodorsal aspects of the proximal interphalangeal and metacarpophalangeal joints were seen. We diagnosed as dermatomyositis on the basis of clinical findings. Interview demonstrated that such rashes were enhanced 1 week after chemotherapy, and got better through following one week. Cutaneous and muscular symptoms got worse two months after her initial visit. Myotonia was found in electromyography, and high density areas on both femoral regions and lower thighs were observed by MRI of skeletal muscle. Scleroderma-like lesions are known as an adverse effect to taxane. In addition, three cases of dermatomyositis due to taxane were reported in Japan. Since dermatomyositis was regarded as one of paraneoplastic syndrome generally, it was not considered as drug-induced. However, clinical course of our case suggests that docetaxel may play more important role in activity of dermatomyositis than ovarian cancer. Seeing patients treated with taxane, therefore, we have to be careful for symptoms suggestive of autoimmune diseases: not only scleroderma but dermatomyositis.