Track: Case Reports

Abstract:

Panniculitis associated with dermatomyositis has been infrequently reported. We present the case of a 61-year-old female with dermatomyositis (anti-TIF1-gamma, anti-SSA/Ro52 positive) in the setting of high-grade ductal breast carcinoma, in remission after treatment with surgery and radiation. Her prior cutaneous manifestations of dermatomyositis included facial rash, periorbital edema, ulcerations on the hands and scalp, and calcinosis cutis. Her disease was partially controlled with rituximab, mycophenolate mofetil, and low-dose prednisone when she developed a new rash on the lateral chest wall. She was found to have a large leathery, red, indurated plaque which raised initial clinical concern for possible carcinoma en cuirasse given her history of breast cancer. Histopathology revealed deep dermal and subcutaneous fibrosis, with fat necrosis and an associated histiocytic reaction. Verhoff-van Gieson stain highlighted thickened dermal elastic fibers in the deep dermis and subcutaneous septae. MRI was additionally obtained which showed dystrophic soft tissue calcifications within the chest wall subcutaneous fat and musculature, with associated intramuscular edema. Overall, the clinicopathologic findings were most consistent with a diagnosis of dermatomyositis panniculitis, although lack of significant lobular lymphocytes or plasma cells is somewhat less typical. The area of skin thickening gradually improved with ongoing systemic immunosuppressive therapy. Dermatomyositis panniculitis is a rarely encountered entity and may represent a precursor to calcinosis cutis through the process of ongoing saponification leading to calcium deposition. This case is unique given the appearance at the site of the patient’s prior breast cancer and radiation therapy, as well as the non-classic histopathologic presentation.

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Andrea Kalus