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Kawasaki disease mimic in rheumatology — SCE Rheumatology MCQ

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HardPaediatric rheumatologyKawasaki disease mimic in rheumatologySCE Rheumatology

A 63-year-old develops dermatomyositis with anti-TIF1-gamma antibodies, dysphagia, weight loss and persistent activity despite initial treatment. CT chest/abdomen/pelvis six months ago was unrevealing. How should malignancy risk be handled?

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Correct answer: E — Basic plus enhanced screening with risk-based repeat surveillance

Explanation lettering: D = shown as A · C = shown as B · A = shown as C · E = shown as D · B = shown as E

B is correct. Adult onset after 40, anti-TIF1-gamma, dysphagia, weight loss and persistent disease are high-risk features. IMACS recommends risk-stratified basic and enhanced screening, with further or repeated assessment when high-risk disease persists despite an initially negative study. A treats one CT as lifetime exclusion. C substitutes muscle enzyme surveillance for cancer assessment. D reverses the antibody association. E uses indiscriminate, radiation-heavy surveillance without a guideline interval. Screening modality should be individualised to sex, age, symptoms and tests already completed.

Reference: IMACS guideline for cancer screening in idiopathic inflammatory myopathy: https://www.nature.com/articles/s41584-023-01045-w