{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:40:07Z","timestamp":1756312807896,"version":"3.44.0"},"reference-count":25,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T00:00:00Z","timestamp":1746403200000},"content-version":"unspecified","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,4,15]]},"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:p>Idiopathic inflammatory myopathies (IIM) represent a diverse group of systemic autoimmune disorders characterised by skeletal muscle weakness with variable clinical manifestations.<\/jats:p>\n               <jats:p>Dermatomyositis (DM) is a heterogeneous IIM and is associated with progressive muscle weakness, with characteristic skin features, and with an increased risk of malignancy. Here, we report a previously healthy man in his early 40s who presented to the emergency department with a 14-day history of symmetric progressive proximal muscle weakness. Both upper arms were painful and swollen, and they displayed marked weakness in arm elevation. Climbing stairs was no longer possible due to muscle weakness and pain. A facial and truncal rash as well as periungual erythema were noted. Laboratory analysis revealed highly elevated creatine kinase. Based on these findings, the diagnosis of DM was confirmed. A comprehensive search for malignancy revealed a non-palpable pure seminoma. While DM as a paraneoplastic phenomenon of seminoma is extremely rare, our case underlines the importance of a thorough tumour search.<\/jats:p>","DOI":"10.1136\/bcr-2024-263689","type":"journal-article","created":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T14:00:20Z","timestamp":1746626420000},"page":"e263689","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Muscle weakness with a hidden cause"],"prefix":"10.1136","volume":"18","author":[{"given":"Sandro Manuel","family":"Mueller","sequence":"first","affiliation":[{"name":"Internal Medicine, Kantonsspital M\u00fcnsterlingen, M\u00fcnsterlingen, TG, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacques Emanuel","family":"Schaefer","sequence":"additional","affiliation":[{"name":"Kantonsspital M\u00fcnsterlingen, M\u00fcnsterlingen, TG, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tibor","family":"Hortobagyi","sequence":"additional","affiliation":[{"name":"Institute of Neuropathology, University Hospital Zurich, Z\u00fcrich, ZH, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Thurnheer","sequence":"additional","affiliation":[{"name":"Internal Medicine, Kantonsspital M\u00fcnsterlingen, M\u00fcnsterlingen, TG, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,5,5]]},"reference":[{"key":"2025082709080304000_18.5.e263689.1","doi-asserted-by":"crossref","first-page":"432","DOI":"10.21037\/atm-20-5215","article-title":"Dermatomyositis and malignancy: should all patients with dermatomyositis undergo malignancy screening?","volume":"9","author":"Khanna","year":"2021","journal-title":"Ann Transl Med"},{"key":"2025082709080304000_18.5.e263689.2","doi-asserted-by":"publisher","DOI":"10.1007\/s40257-015-0120-1"},{"key":"2025082709080304000_18.5.e263689.3","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1177\/1203475416665601","article-title":"Risk of Malignancy in Dermatomyositis and Polymyositis: A Systematic Review and Meta-Analysis","volume":"21","author":"Qiang","year":"2016","journal-title":"J Cutan Med Surg"},{"key":"2025082709080304000_18.5.e263689.4","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-023-01045-w"},{"key":"2025082709080304000_18.5.e263689.5","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.rdc.2020.05.006","article-title":"Risk Factors and Cancer Screening in Myositis","volume":"46","author":"Moghadam-Kia","year":"2020","journal-title":"Rheum Dis Clin North Am"},{"key":"2025082709080304000_18.5.e263689.6","first-page":"1890","article-title":"Research progress on the dermatomyositis specific autoantibodies and malignancy associated dermatomyositis","volume":"48","author":"Xu","year":"2023","journal-title":"Journal of Central South University (Medical Sciences)"},{"key":"2025082709080304000_18.5.e263689.7","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1007\/s12016-022-08922-4","article-title":"Autoantibody Markers of Increased Risk of Malignancy in Patients with Dermatomyositis","volume":"63","author":"Marz\u0119cka","year":"2022","journal-title":"Clin Rev Allergy Immunol"},{"key":"2025082709080304000_18.5.e263689.8","doi-asserted-by":"crossref","first-page":"151","DOI":"10.2147\/ITT.S381472","article-title":"Dermatomyositis: Practical Guidance and Unmet Needs","volume":"13","author":"Cassard","year":"2024","journal-title":"Immunotargets Ther"},{"key":"2025082709080304000_18.5.e263689.9","first-page":"364","article-title":"An update on myositis autoantibodies and insights into pathogenesis","volume":"43","author":"Wang","year":"2025","journal-title":"Clin Exp Rheumatol"},{"key":"2025082709080304000_18.5.e263689.10","unstructured":"Wiendl H , Schmidt J , Bei Berlin R . Myositissyndrome entwicklungsstufe. In: S2k Leitlinien f\u00fcr Diagnostik und Therapie in der Neurologie, www.awmf.org. 2022."},{"key":"2025082709080304000_18.5.e263689.11","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.semarthrit.2020.12.009","article-title":"Overall and site-specific cancer before and after diagnosis of idiopathic inflammatory myopathies: A nationwide study 2002-2016","volume":"51","author":"Dani","year":"2021","journal-title":"Semin Arthritis Rheum"},{"key":"2025082709080304000_18.5.e263689.12","doi-asserted-by":"crossref","first-page":"60","DOI":"10.3892\/mco.2020.2130","article-title":"An extragonadal germ cell tumor with dermatomyositis: A case report and literature review","volume":"13","author":"Fujiwara","year":"2020","journal-title":"Mol Clin Oncol"},{"key":"2025082709080304000_18.5.e263689.13","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1002\/kjm2.12288","article-title":"Paraneoplastic dermatomyositis associated with testicular malignancy","volume":"36","author":"Chiu","year":"2020","journal-title":"Kaohsiung J Med Sci"},{"key":"2025082709080304000_18.5.e263689.14","first-page":"39","article-title":"Paraneoplastic dermatomyositis associated with testicular cancer: a case report and literature review","volume":"19","author":"Dourmishev","year":"2010","journal-title":"Acta Dermatovenerol Alp Pannonica Adriat"},{"key":"2025082709080304000_18.5.e263689.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2022.01.002"},{"key":"2025082709080304000_18.5.e263689.16","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1002\/acr.24786","article-title":"Incidence, Prevalence, and Mortality of Dermatomyositis: A Population-Based Cohort Study","volume":"75","author":"Kronzer","year":"2023","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025082709080304000_18.5.e263689.17","doi-asserted-by":"crossref","DOI":"10.3390\/ijms23084301","article-title":"Pathophysiological Mechanisms and Treatment of Dermatomyositis and Immune Mediated Necrotizing Myopathies: A Focused Review","volume":"23","author":"Kamperman","year":"2022","journal-title":"Int J Mol Sci"},{"key":"2025082709080304000_18.5.e263689.18","doi-asserted-by":"publisher","DOI":"10.1159\/000224860"},{"key":"2025082709080304000_18.5.e263689.19","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-211468"},{"key":"2025082709080304000_18.5.e263689.20","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1007\/s10067-020-05291-1","article-title":"Assessment of diagnostic utility, clinical phenotypic associations, and prognostic significance of anti-NXP2 autoantibody in patients with idiopathic inflammatory myopathies: a systematic review and meta-analysis","volume":"40","author":"Li","year":"2021","journal-title":"Clin Rheumatol"},{"key":"2025082709080304000_18.5.e263689.21","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2018.56"},{"key":"2025082709080304000_18.5.e263689.22","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.14572","article-title":"A systematic review and meta-analysis on the prevalence and clinical characteristics of dysphagia in patients with dermatomyositis","volume":"35","author":"Cheng","year":"2023","journal-title":"Neurogastroenterol Motil"},{"key":"2025082709080304000_18.5.e263689.23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3390\/jcm9072150","article-title":"The Impact of Dysphagia in Myositis: A Systematic Review and Meta-Analysis","volume":"9","author":"Labeit","year":"2020","journal-title":"J Clin Med"},{"key":"2025082709080304000_18.5.e263689.24","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0154746","article-title":"Oropharyngeal Dysphagia in Dermatomyositis: Associations with Clinical and Laboratory Features Including Autoantibodies","volume":"11","author":"Mugii","year":"2016","journal-title":"PLoS ONE"},{"key":"2025082709080304000_18.5.e263689.25","doi-asserted-by":"crossref","unstructured":"Meyer A , Scir\u00e8 CA , Talarico R , et al . Idiopathic inflammatory myopathies: Narrative review of unmet needs in clinical practice guidelines. 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