Remarkable remission of symptomatic dermatomyositis after curative breast cancer surgery.

Dermatomyositis (DM) is an autoimmune disease that causes proximal muscle weakness in the extremities leading to severe immobility and dysphagia. Approximately 20% of patients with DM are positive for anti-TIF-1γ antibody and frequently accompanied by malignant tumors. Although DM remission after tumor resection has been reported, the indications for surgery in patients with severe DM are unknown. Herein, we report a case of a 79-year-old Japanese woman who presented with breast cancer and anti-TIF-1γ antibody-positive DM. She became bedridden shortly after DM onset. Although pulsed steroid therapy, intravenous immunoglobulin, tacrolimus, and endocrine therapy with fulvestrant did not improve her symptoms, tumor resection with axillary lymph node dissection resulted in complete remission of the DM after 8 months. Immunohistochemistry revealed high expression of TIF-1γ in cancer cells, both in the primary tumor and axillary lymph nodes. Since the serum levels of anti-TIF-1γ antibody decreased after the surgery, the existence of breast cancer with TIF-1γ expression may have contributed to the worsening of DM. The present case suggests that curative surgery should be considered as a treatment option even if the patient has severe symptoms, such as immobility and dysphagia. Careful discussions with patients and multidisciplinary collaboration are essential to make surgery feasible, particularly for those with severe symptomatic DM.
Competing Interests: Conflict of interestMasahiro Kawashima received lecture fees from Pfizer Japan Inc., Daiichi Sankyo, Guardant Health AMEA, Eisai Co., Ltd., and Chugai Pharmaceutical Co., Ltd.. Masahiro Kawashima received research fundings from Nippon Kayaku Co., Ltd., and Kyowa Kirin Co., Ltd.. Nobuko Kawaguchi-Sakita has an endowed chair at Fujitsu, Meiji Seika Pharma, Yakult, NTT, PRiME-R, CANNON Medical, HUG, NTT-DATA, and IHC. Masahiro Takada received lecture fees from Chugai Pharmaceutical Co., Ltd., Astra Zeneca K.K., and Daiichi Sankyo. Masahiro Takada received research fundings from Astra Zeneca K.K., Daiichi Sankyo, Eisai Co.,Ltd., KBCRN, JBCRG, ABCSG, Yakult Honsha Co., Ltd., MedBis co., Ltd., and IQVIA Japan. Masakazu Toi has a leadership position of JBCRG, KBCRN, OOTR, and JBCS. Masakazu Toi has an advisory role of Daiichi-Sankyo, Eli Lilly and companies, Bristol Myers Squibb, Athenex Oncology, Bertis Inc., Terumo Corporation, and Kansai Medical Net. Masakazu Toi received lecture fees from Chugai Pharmaceutical Co.,Ltd., Takeda Pharmaceuticals, Pfizer Japan Inc., Kyowa Kirin Co., Ltd., Taiho Pharmaceutical Co., Ltd., Eisai Co., Ltd., Daiichi-Sankyo, Astra Zeneca K.K., Eli Lilly and companies, MSD K.K., EXACT Sciences, Novartis Pharmaceuticals, Shimadzu Corporation, Yakult, Nippon Kayaku Co., Ltd., Devicor Medical Japan K.K., and Sysmex Corporation. Masakazu Toi received research funding from Chugai Pharmaceutical Co., Ltd., Takeda Pharmaceuticals, Pfizer Japan Inc., Taiho Pharmaceutical Co., Ltd., JBCRG, KBCRN, Eisai Co., Ltd., Eli Lilly and companies, Daiichi Sankyo, Astra Zeneca K.K., Astellas Pharma Inc., Shimadzu Corporation, Yakult Honsha Co., Ltd., Nippon Kayaku Co., Ltd., AFI Corporation, Luxonus Inc., Shionogi Pharma Co., Ltd., and GL Sciences Inc.. The other authors declare that they have no conflict of interest.
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