Paraneoplastic dermatomyositis associated with testicular cancer: a case report and literature review.

Dermatomyositis (DM) is frequently associated with neoplastic disorders, mainly carcinomas. However, the association of DM with testicular cancer appears to be very rare. A 37-year-old male was treated for a skin rash on the face and arms with pronounced itching. In December 2005, a testicular swelling and ulceration appeared and a unilateral orchiectomy was performed after a diagnosis of seminoma testis was made. However, the skin rash worsened and symmetric muscle weakness appeared in February 2006. The patient was admitted to the Department of Dermatology, Medical University of Sofia, with characteristic heliotrope erythema, eyelid edema, erythematous plaques on the upper chest, and Gottron's papules on the wrists. Severe muscle weakness was found in the proximal limb muscles. The patient's creatine kinase level was significantly elevated, whereas ASAT and ALAT were within normal ranges. Electromyography and skin biopsy supported a diagnosis of DM. Treatment with moderate corticosteroids and a short course of azathioprine markedly improved the skin lesions and muscle weakness. Even in young patients with DM, the risk of neoplasm is increased. Early recognition of the characteristic skin rash may provide a clue to the diagnosis, and screening for neoplasm may improve the prognosis.