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Acute renal failure associated with dermatomyositis and colon cancer.

Sung Kyew Kang, MD, Department of Internal Medicine, Chonbuk National University Medical School, Chonju, Chonbuk 560-182 (Korea) Dear Sir, Dermatomyositis is a collagen disease characterized by a nonpurulent polymyositis, often accompanied by dermatitis and localized edema. When skin lesions are absent, the condition is referred to as polymyositis. The kidneys are generally spared in dermatomyositis. A few cases of acute renal failure in dermatomyositis have been reported [1–4]. This report describes a case of acute renal failure associated with dermatomyositis and colon cancer in which the renal necropsy showed a typical acute tubular necrosis associated with nontraumatic rhabdomyolysis. Case Report A 49-year-old male patient was admitted with anuria, and proximal muscle weakness. He had had surgery for colon cancer 3 years earlier. The specimen obtained showed poorly differentiated aden-ocarcinoma. On admission he appeared acutely ill. ‘Heliotrope rash’ and eyelid edema were noted on his face. There was no rash on any other part of the body. Neurologic examination showed marked weakness and hypotonia of proximal muscles, especially in the shoulders. Biceps, triceps and knee jerk were hypoactive. Sensation and superficial reflexes were normal. He was anuric. The laboratory findings revealed Hb 10.5 g/dl; WBC 6,900/mm3 with differential count showing neutrophils 75%, lymphocytes 15%. ESR was 116 mm/h. Serum Na was 140 mEq/1, K 7.0 mEq/1, P 4.0 mg/dl, uric acid 11.8 mg/dl, albumin 2.9 g/dl and globulin 3.0 g/dl. Serum creatine kinase was 144 U/l, lactic dehydrogenase 203 U/l, SGOT 265 U/l, SGPT113 U/l. BUN was 84 mg/dl and creatinine was 13.9 mg/dl. A skin biopsy of the rash on the face revealed flattening of the rete ridge and liquefactive degeneration of basal cell layer. A biopsy of the deltoid muscle showed edema between muscle fibers, variable diameter of muscle fibers, massive fiber necrosis, and perivascular infiltration of acute and chronic inflammatory cells. Electromyogram revealed myopathic findings compatible with dermatomyositis. Computed tomographic scanning of abdomen showed extensive obstructive uropathy in both midureters due to retroperitoneal lymphadenopathy but no evidence of liver metastasis. He had hemodialysis 3 times via subclavian catheter but refused further treatment. Two weeks later the patient died of uremia and sepsis with pneumonia. A renal necropsy performed just after death revealed focal, severe necrosis of the tubular epithelium with pigmented casts in the lumens. Interstitial tissue