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Acute Dermatomyositis Associated with Squamous Carcinoma of the Oesophagus

Case report A 63-year-old advertising consultant presented in July 1983 with a three-month history of epigastric discomfort after meals, abdominal bloating, intermittent regurgitation of food and the loss of one stone (6.3 kg) in weight. He had a past medical history of hypertension and had suffered a transient ischaemic attack 7 months previously when he was noted to have early clubbing. He was taking atenolol and aspirin, was a pipe smoker and consumed moderate quantities of alcohol. Physical examination now revealed marked clubbing and he was also noted to have palmar erythema. Routine blood investigations were normal. An upper gastrointestinal endoscopy revealed an extensive, ulcerating polypoidal carcinoma of the oesophagus extending 25-35 cm from the incisor teeth. The endoscope could not be passed distally. Biopsies showed this to be a poorly differentiated squamous cell carcinoma. Following a small haematemesis he received a split course of radiotherapy, with an initial 3000 cGy being administered in 8 fractions over two weeks and the same dose again six weeks later. He tolerated this very well, with considerable improvement in his swallowing and weight gain. Three weeks after completion of his radiotherapy he suddenly developed pain and weakness in his proximal limb muscles, a generalized itchy desquamating skin rash and lethargy. These symptoms rapidly progressed and he was admitted to hospital three weeks later. Examination revealed marked finger clubbing and a florid magenta-coloured scaly eruption on his face including both upper eyelids, the nape of his neck, elbows, forearms, dorsal hands, interphalangeal joints and dorsal proximal phalanges. There was nail-fold telangiectasia and slight scarring of the fingers, particularly both little fingers.