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The incidence of malignancy in patients with dermatomyositis is about 5 to 7 times greater than that of the general population.1 The most common malignancies associated with dermatomyositis include adenocarcinomas of the lung, ovaries, cervix, pancreas, and stomach.1, 2, 3, 4 Several factors have been reported as possible predictors of paraneoplastic disease, which include older age at diagnosis, male sex, autoantibodies to transcription intermediary factor 1-γ, nuclear matrix protein-2, elevated erythrocyte sedimentation rate, cutaneous necrosis, and antinuclear antibody negativity.3, 4, 5, 6, 7  In our practice, we noticed that dermatomyositis recalcitrant to therapy may be an additional predictor of underlying malignancy. We classified recalcitrant dermatomyositis as having both cutaneous and muscle disease resistant to appropriate treatment, with the exception of resistant skin disease only in an amyopathic case. Here we report 3 cases.

Dermatomyositis recalcitrant to treatment associated with occult malignancy