Case report: atypical anti-SAE1 autoantibody manifestation with splinter hemorrhages as onset, and related to urothelial cancer.

UNLABELLED:

BACKGROUND

Subungual splinter hemorrhages may represent an expression of infective endocarditis as well as autoimmune diseases or neoplasms. Anti-SAE1 autoantibody is directed against a small ubiquitin-like modifier-activating enzyme that plays a role in regulating transcription, cell cycle, and apoptosis. It is specific for dermatomyositis with skin rash and mild muscle involvement, and it can be associated with cancer.  CASE REPORT: We describe the case of a patient who developed subungual splinter hemorrhages and acrocyanosis. Infections were excluded, and autoimmunity resulted in anti-SAE1 autoantibodies. A cancer screening found a high-grade urothelial carcinoma. The splinter hemorrhages disappeared after the carcinoma enucleation.

CONCLUSIONS

Our case describes an atypical onset of anti-SAE1 dermatomyositis with splinter hemorrhages, potentially linked to urothelial cancer. This highlights the importance of comprehensive cancer screening in patients with unusual dermatomyositis presentations.

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