Recurrent dermatomyositis manifesting as a sign of recurrent transitional cell carcinoma of urinary bladder: Long-term survival
John Fitzpatrick1, William A. Wallace2, Stephen Lang3, Omar M. Aboumarzouk1, Phyllis Windsor4, Ghulam Nabi1
1 Department of Urology, Ninewells Hospital (NHS Tayside), Medical School, Medical Research Institute, University of Dundee, Dundee, Scotland (UK), DD1 9SY
2 Department of Pathology, Royal Infirmary of Edinburgh (NHS Lothian), 51 Little France Crescent, Edinburgh EH16 4SA, Scotland
3 Department of Pathology, Ninewells Hospital (NHS Tayside), Medical School, Medical Research Institute, University of Dundee, Dundee, Scotland (UK), DD1 9SY
4 Department of Radiation Oncology, Ninewells Hospital (NHS Tayside), Medical School, Medical Research Institute, University of Dundee, Dundee, Scotland (UK), DD1 9SY
Senior Clinical Lecturer in Surgical Uro oncology, Consultant Urological Surgeon, Medical Research Institute, Ninewells Hospital and Medical School, Dundee, Scotland, UK
The association between urological malignancies and paraneoplastic syndromes has been well documented. We report a case of recurrent dermatomyositis manifesting as a sign of metastatic recurrence of non-muscle-invasive transitional cell carcinoma of the bladder, a relationship which has only been referred to in a few reports. The case highlights a few important clinical challenges; firstly, the importance of thorough investigation for underlying malignancy in patients with dermatomyositis, as successful treatment of such malignancy can lead to resolution of paraneoplastic symptoms, and secondly, a high index of suspicion of recurrence in cases where paraneoplastic manifestations recur. Metastatic pulmonary recurrence without local evidence of disease at a follow-up of 4 years makes this case unique. Moreover, in the light of our experience and reported literature, a framework is suggested to approach such a diagnostic dilemma in the future. Description of the case will guide clinicians in the future, in case they encounter such an unusual clinical scenario. This could also serve as a hypothesis-generating source for designing future research as well.