case_images: PMC11790588_01
case_images: Clinical timeline for the patient.
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case_images: Surgery ( Figure 1 ).
case_images: Pathological findings of the resected specimen showing, (A) a characteristic appearance of papillary thyroid carcinoma (PTC), with the presence of papillary structures and enlarged, irregular nuclei. (100x); (B) a high-grade, poorly differentiated breast invasive ductal carcinoma with irregular nuclear contours and prominent nucleoli. (200x).
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case_images: According to the final surgical pathology ( Figure 2A ), it showed a characteristic appearance of PTC, with the presence of papillary structures and enlarged, irregular nuclei. The pathology report revealed Grade III invasive ductal carcinoma ( Figure 2B ).
case_images: Clinical features of the patient. (A) Edema with heliotrope rash of the bilateral eyelids. (B) V-neck signs of the chest. (C) shawl-sign rash (macular exanthema on the back site of neck). (D) Gottron's signs of the elbows. (E) Gottron's signs of the dorsal side of finger joints. (F) Mechanic's Hands with periungual hemorrhage and thickening of the nail cuticle.
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case_images: Physical examination revealed facial edema and generalized skin eruption, heliotrope rash of the bilateral eyelids, V-neck signs of the chest, Gottron's signs of the knees and elbows, Holster's sign, and shawl's sign ( Figure 3 ).
case_images: Temporal changes of creatinine kinase (CK) and lactate dehydrogenase (LDH). Treatments performed are indicated above the graph. PSL indicates prednisolone; mPSL, methylprednisolone; IVIg, intravenous immunoglobulin.
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case_images: Laboratory examination showed a significantly increased creatine phosphokinase (CK) level (1608 IU/L with a normal laboratory range of 40-200 IU/L,  Figure 4 ), and testing for myositis-specific and myositis-associated autoantibodies showed that the antinuclear antibody was reactive (titer 1:100) with a speckled pattern, anti-Ro-52 antibody with a strong positive reaction, and anti-TIF-1gamma antibody with a weak positive reaction.
case_images: Pathological findings of the biopsy specimen showing, (A) cervical skin with chronic inflammatory cell infiltration around small blood vessels; (B) deltoid muscle biopsy with focal infiltration of chronic inflammatory cells between muscle bundles. (hematoxylin and eosin section, 100x).
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case_images: Cervical skin biopsy showed chronic inflammatory cell infiltration around the small blood vessels ( Figure 5A ). Deltoid muscle biopsy showed focal infiltration of chronic inflammatory cells between the muscle bundles ( Figure 5B ).
case_images: Timeline history of drug administration.
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case_images: Methylprednisolone (mPSL) was administered intravenously at a dose of 80 mg/d ( Figure 6 ).