Inflammatory myopathy and cancer: rare association of seminoma testes and polymyositis.

摘要

A 50-year-old man presented in December 2003 with myalgias and weakness affecting limbs and torso. He had noticed a gradual onset of difficulty rising from a chair, getting objects from overhead along with mild stiffness of the limbs. He denied any symptoms of arthritis, skin rash, Raynaud's phenomenon, sclerodactyly, breathlessness,fever or weight loss. On examination, there was significant tenderness in the thigh muscles along with a marked proximal muscle weakness of extremities (Medical Research Council grade 2/5) and mild weakness of truncal muscles. There was no evidence of weakness in his oculax, neck or pharyngeal musculature. The sensory examination and deep tendon reflexes were normal. There was no evidence of rash on his hands, particularlyknuckles, back of the neck or periorbital region. Systemic examination was unremarkable; in particular, there was no evidence of malignancy. His blood tests showed markedly increased creatine kinase (CK) levels to 10 569 U/L (N 0-270 U/L). The remainder ofhis haematological and biochemistry parameters, including lactate dehydrogenase(LDH), aspartate aminotransferase (AST) and alanineaminotransferase (ALT), were normal. A clinical diagnosis of inflammatory myopathy was made, which was confirmed with a muscle biopsy of right vastus lateralis, which showed the presence of a focal chronic inflammatory cell infiltrate in the endomysium and perimysium,plus a few degenerateecrotic fibres, features consistent with inflammatory myopathy. Electron microscopy and quantitative histochemistry were non-contributory. An electromyography was not carried out. He also had low-titre antinuclear antibodies (1:80 speckled), but the extractable nuclear antigen (including anti-Jo I) was negative. He was euthyroid, and negative for viral antibodies. Chest radiograph, prostate-specific antigen and colonoscopy were normal.