Immunotherapy-intensified paraneoplastic dermatomyositis
A Estenaga 1 , N Rodriguez-Garijo 1 , A Tomás-Velázquez 1 , J Antoñanzas-Pérez 1 , M L Alvarez-Gigli 2 , L García-Tobar 2 , A Espaa-Alonso 1 , R Salido-Vallejo 1
Atezolizumab is an immune checkpoint inhibitor that binds to programmed death-ligand 1, enhancing T-cell response to cancer. In parallel to anti-tumor immune response, it can promote autoimmunity. Dermatomyositis is an autoimmune disease characterized by proximal muscle inflammation, typical skin manifestations and systemic findings. In a subset of adults, it is associated with malignancies or it can be drug related.1
A 78-year-old man presented with a photodistributed erythematoviolaceous eruption, facial edema and painful erythema on the nailfolds [Figures 1a-c]. He complained of proximal muscle weakness and myalgia. Musculoskeletal examination revealed grade 3/5 strength on abduction against resistance in the right shoulder and 2/5 in his left shoulder, as well as limited flexion of both hips...