Robot-assisted surgery for rectal cancer with tumor-associated dermatomyositis during preoperative chemotherapy: A case report and literature review

Abstract

RATIONALE: Dermatomyositis (DM) is a systemic inflammatory disorder involving the muscles and skin and is often associated with malignancies in adults. Anti-transcriptional intermediary factor 1-gamma (anti-TIF1-γ) antibodies are specific markers of a subset of DM with a high risk of cancer, highlighting the importance of recognizing this paraneoplastic syndrome for early diagnosis and treatment. This report describes a rare case of tumor-associated DM that developed during chemotherapy for advanced rectal cancer and emphasizes the importance of multidisciplinary management in such conditions. PATIENT CONCERNS: A 75-year-old woman presented with rectal bleeding and progressive symptoms, including severe erythema, rash, muscle weakness, and general fatigue, following preoperative chemotherapy for rectal cancer. The symptoms severely impacted her quality of life, raising concerns about a potential paraneoplastic syndrome. DIAGNOSES: The patient was diagnosed with tumor-associated DM based on clinical findings of a heliotrope rash, Gottron's sign, and elevated muscle enzyme levels. The presence of anti-TIF1-γ antibodies confirmed the diagnosis. Preoperative evaluation identified rectal cancer as stage IIa (pT3, N0, M0) and the likely underlying malignancy contributing to DM. INTERVENTIONS: The patient underwent immunotherapy with steroids and high-dose intravenous immunoglobulin, which stabilized her condition. Subsequently, a robot-assisted Hartmann's operation was performed to resect the rectal tumor and establish a colostomy. Postoperative care included monitoring for DM symptom resolution and managing her nutritional and rehabilitation needs. OUTCOMES: Within 3 weeks of surgery, the patient's muscle enzyme levels normalized, and her symptoms, including erythema and muscle weakness, resolved. Follow-up evaluations showed no recurrence of DM or cancer over the subsequent year, indicating a successful outcome with a multidisciplinary approach. LESSONS: This case underscores the importance of early recognition and management of paraneoplastic syndromes such as tumor-associated DM. A multidisciplinary approach combining immunotherapy and surgical intervention for the underlying malignancy can lead to favorable outcomes. This case also highlights the significance of long-term monitoring for both cancer recurrence and autoimmune complications in such patients.