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Dermatomyositis – Malignancy Screening — SCE Neurology MCQ

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ModeratePeripheral Neuropathy & NeuromuscularDermatomyositis – Malignancy ScreeningSCE Neurology

A 40-year-old man presents with a 2-year history of progressive proximal upper and lower limb weakness, myalgia, and an elevated CK (4,500 IU/L). He has a heliotrope rash around both eyelids and Gottron papules over the metacarpophalangeal joints. Muscle biopsy shows perifascicular atrophy and perivascular inflammatory infiltrate. What essential investigation must be performed to exclude a common association?

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Correct answer: D — CT chest, abdomen, and pelvis to screen for underlying malignancy

Dermatomyositis in adults is associated with an underlying malignancy in approximately 15–25% of cases, particularly in those over 40. Common associated cancers include ovarian, lung, pancreatic, stomach, and colorectal cancers. A thorough malignancy screen (CT TAP, consideration of age/sex-appropriate screening) is mandatory at diagnosis and should be repeated periodically. A: LP is not routinely indicated. C: The biopsy findings (perifascicular atrophy, perivascular inflammation) confirm inflammatory myopathy, not dystrophy. D: NCS are normal in myopathy. E: HLA typing has no immediate clinical utility.

Reference: ABN Inflammatory Myopathy Guidelines; EAN/ENMC Dermatomyositis Guidelines