Introduction/Background Paraneoplastic dermatomyositis (DM) is a rare manifestation of ovarian cancer (OC); indeed only 110 cases have been reported in literature. Heliotrope rash, Gottron’s papules and weakness of proximal muscles of the limbs are the main symptoms of DM, but in association with cancer presentation, it has more complications, higher hospitalization rate and worse prognosis.

Methodology Revision of literature

Results We present a patient whose first symptom of advanced stage OC was a rapidly worsening DM with dysphagia requiring naso-gastric feeding, complicated by pulmonary embolism, muscular hematoma, atrial fibrillation, and who needed one month of hospitalization. Diagnosis of OC was made after biopsy of an enlarged inguinal lymph node, which the patient self noticed, while tumor markers (TM), gynecological examination and imaging techniques were negative for mullerian neoplasia. High dose corticosteroids (75mg a day of prednisone) were needed to treat DM during hospitalization, but it only recovered when Carboplatin AUC 5 d1q21 neoadjuvant chemotherapy was started. Then DM reappeared with disease progression during chemotherapy and at recurrence after cytoreductive surgery.

Conclusion 3 to 40% of DM are paraneoplastic: ovarian, colorectal, breast and lung cancer are most frequently related, so every patient with DM must be carefully evaluated in order to identify or exclude malignancy. Every woman with DM has to be assessed by a gynecologist, and then referred to an oncological gynecologist if OC is detected in order to receive appropriate treatment; patients with family history of OC and breast cancer have to be carefully evaluated during time, since OC may be occult. During OC treatment and follow up, in a patient with paraneoplastic DM, the cutaneous and muscular symptoms have to be investigated because they represent a red flag to identify recurrence or disease progression.

Disclosures The authors have indicated they have no conflicts of interest