Dermatomiositis asociada a cáncer testicular mixto en paciente joven: reporte de un caso y revisión de la literatura

La dermatomiositis se caracteriza por su compromiso cutaneo y muscular, siendo rara su asociacion a canceres seminomatosos y no seminomatosos en un mismo paciente. Se presenta el caso de un paciente de sexo masculino, de 31anos, con tres meses de mialgias y eritema heliotropo en cara acompanado de erupcion maculo-papular en areas fotoexpuestas y yuxta-articulares, asociado a un aumento de volumen testicular izquierdo. La CK, beta-HCG, GOT, GPT, LDH, y alfa-feto proteina estaban elevadas. La biopsia muscular informo miositis intersticial y el estudio histopatologico testicular evidencio un cancer testicular mixto con seminoma, teratocarcinoma y carcinoma embrionario. No presento metastasis. Se trato con prednisona y orquiectomia, constatandose disminucion progresiva del compromiso cutaneo en los meses siguientes a la cirugia. Los reportes publicados enfatizan medir alfa-feto proteina y beta-HCG, y examinar los testiculos en pacientes jovenes con dermatomiositis. Todos los casos publicados presentaron una evolucion rapida. La sobrevida esta relacionada con el volumen tumoral y la elevacion de marcadores. La resolucion del cuadro dermatologico dependera de la sospecha precoz y el oportuno tratamiento de la patologia de base. Dermatomyositis is characterized for skin and muscular involvement, being rare its association with seminomatous and non seminomatous germ cell cancers, both in the same patient. The clinical case is a male patient 31 years old, with a story of three months of mialgies and heliotrope rash in face, and maculopapular lesions in photoexposed and juxta-articular areas, associated with left testicle increased in size. CK, beta-HCG, GOT, GPT, LDH, and alpha-fetoprotein were elevated. Muscular biopsy informed interstitial myositis; the histopathological study of a testicle tissue biopsy showed mixed testicular cancer with seminoma, teratocarcinoma, and embryonal carcinoma. No metastasis were found. He was treated with prednisone and orchiectomy, watching a progressive decrease of the cutaneous involvement over the next months after surgery. Literature reports remark to measure alpha-fetoprotein and beta-HCG, and to exam both testicles in young patients with dermatomyositis. All published cases had a rapid evolution. Survival is related with tumor size and elevation of serum markers. Resolution of the dermatologic features will depend on clinical suspicious and opportune treatment of the cancer.