Abstract
A 65 year-old male was admitted on September 1, 1977 complaining of edematous erythema, myalgia, swallowing disturbance, productive cough and exertional dyspnea. Physical examination showed widespread poikilodermia, muscle weakness, decreased deep tendon reflex, clubbed fingers, Velcro rales on the back base of chest and no lymphadenopathy. Chest X-ray demonstrated diffuse interstitial infiltrates in lower bases and a large mass in the right lower lobe. Lung function tests showed a restrictive pattern, decreased diffusion capacity and hypoxemia without hypercapnia. Electromyogram showed a myogenic pattern, serum creatinine phosphokinase level was high and urinal excretion of creatine was excessive. Biopsies of skin and muscle revealed typical dermatomyositis. Cytology of sputum was class V and squamous cell carcinoma was suspected. Generalized chemotherapy and corticosteroid administration were performed, which were not effective and the patient expired on the 43rd hospital day.
Autopsy revealed interstitial pneumonia or pulmonary fibrosis with honeycomb appearance in both lungs, especially in the lower lobes, and syncronous multiple lung cancers, squamous cell carcinomas in the right S10 and left S1+2, a poorly differentiated adenocarcinoma in the right S4 and a small cell carcinoma in the left S4, which had metastasized to both hilar nodes.
