Dermatomyositis Identified During Palliative Care Management for Chemotherapy-Associated Pain: A Case Report

Introduction: Skin disorders and neuropathy often occur as side effects of chemotherapy. We encountered a patient who was treated for drug-induced skin symptoms, but the symptoms did not improve, and he was eventually diagnosed as having dermatomyositis. Case presentation: A 71-year-old man underwent chemotherapy with regorafenib in February 2020 for the postoperative recurrence of sigmoid colon cancer, but treatment was discontinued after about 2 months owing to the appearance of skin symptoms, which were thought to be side effects of regorafenib. Subsequently, his symptoms further worsened, and he was hospitalized 3 weeks after the appearance of the initial skin symptoms, and a palliative care team was asked to relieve his back pain caused by the drug-induced skin symptoms. Erythema was widely observed on the lower back and limbs, and he experienced needle stick-like pain. Furthermore, the patient demonstrated difficulty in lifting both upper limbs. As acetaminophen was effective for his pain, the dose was slowly increased with careful observation. The cause of the patient’s muscle weakness was unclear, and after careful discussion of the possible causes among specialists in dermatology, neurology, and rheumatoid arthritis, a diagnosis of dermatomyositis associated with the malignant tumor was made about 10 days after his admission. The patient’s symptoms gradually improved with steroid pulse treatment (methylprednisolone 1 g/day for 3 days) followed by high-dose gamma globulin treatment (2.5 g/day for 5 days), and the patient was discharged 48 days after admission. Discussion: Because this patient was referred to a palliative care team for the purpose of relieving pain caused by skin symptoms associated with chemotherapy, a crucial point is the symptoms were treated as side effects of the chemotherapy from the beginning. As neuropathy can occur as a result of chemotherapy, the pain and muscle weakness could be explained at the time; however, the symptoms continued to worsen even after the chemotherapy was stopped. Because the symptoms were not typical of polymyositis/dermatomyositis, diagnosis of the patient was delayed, even though he was treated in each specialized department. Our present case indicates that paraneoplastic syndrome should always be kept in mind when treating cancer patients.

A rare complication in a Covid-19 positive patient with sigmoid colon cancer-hemoperitoneum due to gallbladder necrosis following micro-thrombosis

Covid-19, also known as acute respiratory syndrome 2019-nCoV, severe acute respiratory syndrome (SARS) 2, and Wuhan pneumonia, is a viral respiratory disease caused by a SARS-associated coronavirus (SARS-CoV2). The most serious complications of Covid-19 are due to the development of micro-thrombosis in various organs and systems as a result of the high levels of pro-inflammatory cytokines (tumor necrosis factor alpha, interleukin 1 and 6) which initiate the activation of coagulation and the generation of thrombin. Several studies demonstrated the poor outcome of Covid-19-infected patients who underwent surgery, suggesting that surgery may accelerate and exacerbate Covid-19 progression. We report the case of an 81-year-old patient admitted as an emergency with Covid-19 pneumonia, hemoperitoneum, ischemic acute cholecystitis and obstructive sigmoid cancer. Cholecystectomy, pneumoperitoneal lavage, and Hartmann operation were performed under combined epidural-spinal anesthesia. This technique has some advantages compared to spinal and epidural techniques, such as: rapid onset of analgesia and the possibility of obtaining the desired sensory level, control of the anesthetic block, and ensuring postoperative analgesia. The unfavorable outcome of this case is due to the occurrence of the cytokine storm and coagulation disorders, with the change in the related biological constants, both from a biochemical and systemic point of view.

Efficacy Comparison and Safety Analysis of Radical Resection of Sigmoid Colon Cancer Based on Different Cancer Locations

Background: Sigmoid colon cancer is a common type of colon cancer; it refers to tumor lesions occurring in the segment approximately 16 cm to 50 cm from the anal margin. Currently, surgical resection is the most effective treatment for non-metastatic sigmoid colon cancer. Therefore, to more accurately standardize colon cancer surgery, we classified the sigmoid colon into distal and proximal segments. This study compares and analyzes the intraoperative situation, postoperative pathology and safety of radical resection of sigmoid cancer in different locations from different aspects. Result: The patients with sigmoid colon tumor can be divided into distal group (16-30cm from the anus) and proximal group (31-50cm from the anus) according to the distance between the tumor and the anal margin. Conclusion: The patients in the distal group using stapler for intestinal anastomosis and anal decompression tube were significantly more than those in the proximal group. For the ligation of the inferior mesenteric artery, high ligation was usually used or the left colic artery was usually preserved in the distal group, and the superior rectal artery was usually retained in the proximal group. The incidence of postoperative complications in the distal group was higher than that in the proximal group, but there was no significant difference between the two groups.