(335) Non-Small Lung Cancer of the Hypopharynx Initially Presenting as Dermatomyositis

Introduction: Dermatomyositis (DM) is a systemic autoimmune disease that affects multiple organ systems and is associated with malignancies. However, the ENT manifestations of DM in this context is not well understood.

Methods: This is a case report of a 73-year-old male patient who presented to the ED with facial swelling, rash, bilateral deltoid pain, and progressive dysphagia.

Results: Our patient's initial diagnostic workup consisted of a CT scan with contrast. The scan demonstrated cervical lymphadenopathy and effacement of the left piriform sinus with suspected edema but no discernible mass. Labs demonstrated a markedly elevated CK of 1,239 and dermatomyositis was suspected. He was given dexamethasone and discharged.

One month later, the patient was admitted to the hospital with similar symptoms. A deltoid muscle biopsy confirmed a diagnosis of dermatomyositis. He developed dysphagia during his hospital stay and an EGD and laryngoscopy were both negative. CT scan re-demonstrated left cervical node lymphadenopathy and a cervical lymph node biopsy was taken. Biopsy was positive for metastatic non-small cell carcinoma; however, no primary source was identified.

The patient was admitted to the hospital approximately one month later with progressive dysphagia, decreased appetite, and weight loss. He also had re-demonstrated his symptoms from before. The patient was started on corticosteroids and all symptoms improved except his dysphagia. An exam under anesthesia was performed and he was identified to have a level 3 neck mass in the piriform sinus that was positive for non-small cell carcinoma. The patient underwent left transoral CO2 laser partial laryngopharyngectomy, total thyroidectomy with bilateral neck dissection with adjuvant chemoradiation.

Conclusions: This case emphasizes DM as an initial presenting symptom of head and neck cancer and the importance of early involvement of ENT when other diagnostic studies, such as CT scan, are suspicious for malignancy. Early detection of head and neck cancer would lead to better outcomes, more favorable prognoses, and fewer visits to the ED for associated complications.