title: Dermatomyositis in a Patient with Cholangiocarcinoma Detected by an [(18)F]-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Scan.
abstract: Cholangiocarcinoma with paraneoplastic dermatomyositis (DM) is extremely rare, and the whole body positron emission tomography-computed tomography (PET-CT) finding of paraneoplastic DM is rarely reported. We report a 66-year-old woman with metastatic cholangiocarcinoma, initially presented with bilateral proximal muscle uptake on PET-CT without clinical muscle symptoms. The initial interpretation of the high muscle uptake was metastasis to the muscles. However, while awaiting for chemotherapy, muscle weakness evolved and rapidly progressed. The level of creatine phosphokinase was significantly elevated. Electromyography revealed moderate myopathy, and a muscle biopsy showed degenerating myofibers with variable sizes. The diagnosis of paraneoplastic dermatomyositis was made. This case highlights that, although rare, paraneoplastic dermatomyositis can be present with cholangiocarcinoma. Also, muscle inflammation can precede the clinical muscle symptoms, and paraneoplastic DM should be considered as a possible differential diagnosis in the assessment of cancer patients who present with abnormal muscle tracer uptake in PET-CT scans.
authors: Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors: Koung Jin
authors: KJ
authors: Suh
authors: Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors: Jin Kyun
authors: JK
authors: Park
authors: Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors: Seongcheol
authors: S
authors: Cho
authors: Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors: Hyunkyung
authors: H
authors: Park
authors: Department of Pathology, Seoul National University Hospital, Seoul, Korea.
authors: Hae Woon
authors: HW
authors: Baek
authors: Department of Pathology, Seoul National University Hospital, Seoul, Korea.
authors: Kyoungbun
authors: K
authors: Lee
authors: Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea.
authors: Dong Soo
authors: DS
authors: Lee
authors: Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.|Cancer Research Institute, Seoul National University, Seoul, Korea.
authors: Kyung-Hun
authors: KH
authors: Lee
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications*; D018281:Cholangiocarcinoma / Q000150:complications*; D003882:Dermatomyositis / Q000150:complications* / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D010257:Paraneoplastic Syndromes / Q000150:complications* / Q000000981:diagnostic imaging*; D000072078:Positron Emission Tomography Computed Tomography
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: Cholangiocarcinoma; Dermatomyositis; Positron-emission tomography