PMC5790732_01
Erythema after anthracycline/cyclophosphamide chemotherapy. Millet-sized blisters developed on the trunk with itching.
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During the first course of chemotherapy, she developed erythema on the right shoulder and chest wall, which spread after the second course was started (Fig. 1).
Clinical course. Acute pharyngitis developed in February and was treated with antibiotics. Unfortunately, CK had never been evaluated before the development of DM. A/C: adriamycin/cyclophosphamide, CK: creatine kinase, CRP: C-reactive protein, DM: dermatomyositis, LD: lactate dehydrogenase, PSL: prednisolone, PTX: paclitaxel
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Although she developed acute pharyngitis in February, the scheduled 12 courses of chemotherapy was completed, and mastectomy and axillary node dissection were performed in March 2016 (Fig. 2). After the operation, flurbiprofen, pentazocine, loxoprofen, and rebamipide were administered temporarily; however, no other drugs such as antibiotics were used. PSL, her symptoms, including erythema and muscular weakness, quickly improved, and the serum CK level also decreased. PSL was tapered, and she was discharged at the end of May 2016 (Fig. 2).
Rash at the time of admission. A) Heliotrope erythema with facial edema. B) Shawl sign. C) Gottron's sign on the elbow. D) Gottron's papules. E) A blister on the forearm.
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On admission, swelling erythemas were found on her eyelids, erythematous papules on the dorsum of the metacarpophalangeal joints, and a flat red rash over the back of the elbows; these rashes are compatible with heliotrope erythema, Gottron's papules, and Gottron's sign (Fig. 3). Furthermore, periungual erythema was found with widespread erythema and facial edema (Fig. 3). The blisters were observed on both forearms, and a shawl sign was also observed (Fig. 3).
Magnetic resonance imaging of the right shoulder. (A) Widespread enhancement of the rotator cuff muscles and deltoid muscle (arrow). (B) Tendon rupture of the supraspinatus muscle (arrow).
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Manual muscle testing showed deltoid and quadriceps weakness, and magnetic resonance imaging showed the enhancement of the deltoid muscle and rotator cuff (Fig. 4).