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Paraneoplastic Dermatomyositis — RACP Adult Medicine MCQ

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EasyRheumatologyParaneoplastic DermatomyositisRACP Adult Medicine

A 55-year-old woman presents with proximal muscle weakness, a heliotrope (violaceous) rash on her upper eyelids, Gottron papules over her MCP and IP joints, and V-sign erythema on the anterior chest. CK is elevated (4500 U/L). CT shows a 5 cm ovarian mass. What is the most likely paraneoplastic skin sign?

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Correct answer: A — Dermatomyositis (heliotrope/Gottron)

Heliotrope rash (pathognomonic violaceous discoloration of upper eyelids), Gottron papules (violaceous papules over MCP/IP joints), V-sign erythema, proximal weakness, elevated CK, and ovarian mass is dermatomyositis with underlying malignancy. Malignancy screening is mandatory in all adults with DM (15-25% have occult cancer within 3 years of diagnosis). CT chest/abdomen/pelvis, age-appropriate cancer screening, and gynaecological evaluation are required.

Reference: ACR/EULAR – 2017 – IIM; eTG Rheumatology 2024