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Kosuke Ono

Manabu Shimomura

Kazuhiro Toyota

Atsushi Kagimoto

Naofumi Tsukiyama

Masayuki Shishida

Koichi Oishi

Kazuaki Miyamoto

Satoshi Shibata

Masahiro Ikeda

Seiji Sadamoto

Tadateru Takahashi

CASE REPORT Open Access
Successful resection of liver metastasis
detected by exacerbation of skin symptom
in a patient with dermatomyositis
accompanied by rectal cancer: a case
report and literature review
Kosuke Ono1, Manabu Shimomura1*, Kazuhiro Toyota1, Atsushi Kagimoto1, Naofumi Tsukiyama1,
Masayuki Shishida1, Koichi Oishi1, Kazuaki Miyamoto1, Satoshi Shibata1, Masahiro Ikeda1, Seiji Sadamoto1
and Tadateru Takahashi1,2
Abstract
Background: Dermatomyositis (DM) is a rare syndrome that belongs to the group of idiopathic inflammatory
myopathies. The association between DM and malignancy is well recognized, and the severity of DM symptoms
has been linked to the progression of metastatic disease.
Case presentation: We report the case of a 42-year-old man that was diagnosed with dermatomyositis (DM) and
rectal cancer. Proctectomy was performed, and DM symptoms were resolved postoperatively. One year and 9 months
after the surgery, liver metastasis occurred accompanied by the exacerbation of DM symptom. Partial resection of the
liver was performed, and postoperative course was uneventful. DM symptoms improved postoperatively, and no
evidence of cancer recurrence or DM symptoms was observed 2 years after the second surgery. To date, few reports
have described recurring cases of DM accompanied by colorectal cancer in detail. We reviewed four similar cases that
were reported poor prognoses with treatment resistance. However, our case report demonstrates good long-term
results with resection of metastatic lesion.
Conclusions: It is important to check the exacerbation of DM symptoms, as this symptom sometimes preceded cancer
relapse during the follow-up of our patient with DM and colorectal cancer.
Keywords: Dermatomyositis, Colorectal cancer, Recurrence, Liver metastasis
Background
Dermatomyositis (DM) is a rare syndrome that belongs to
the group of idiopathic inflammatory myopathies. It is
characterized by heliotrope rashes, Gottron’s papules, and
proximal muscle weakness [1, 2]. The association between
DM and malignancy has been well recognized for many
years [3]. In particular, DM has been linked to tumors in
the ovaries, lungs, pancreas, and stomach; as well as non-
Hodgkin’s lymphoma, and sometimes, colorectal cancer
[4]. Malignancies are usually diagnosed within a year from
the onset of myopathy, and the extent of DM symptoms
has been associated with the progression of metastatic
diseases [5]. Recent reports have demonstrated the rela-
tionship between the exacerbation of DM symptoms and
cancer recurrence [6].
We report a case of a patient who presented with DM
and colorectal cancer, and underwent curative resection
for liver metastasis that was detected by the exacerbation
of DM symptom. We also reviewed similar reported
cases and analyzed the clinicopathological features of
* Correspondence: manabus761215@gmail.com
1Department of Surgery, National Hospital Organization Higashihiroshima
Medical Center, 513, Jike, Saijyo-cho, Higashihiroshima, Hiroshima 739-0041,
Japan
Full list of author information is available at the end of the article
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made.
Ono et al. Surgical Case Reports  (2017) 3:3 
DOI 10.1186/s40792-016-0281-z
patients with DM accompanied by recurrent colorectal
cancer.
Case presentation
A 42-year-old man presented with a skin rash on his
face and finger (Fig. 1). His past history included an ap-
pendectomy at 15 years old. There was no family history.
The patient was diagnosed with DM based on the pres-
ence of a heliotrope rash, Gottron’s papules, dysphagia,
proximal muscle weakness, and raised muscle-associated
enzyme levels; Jo-1 antibody was negative. He under-
went medical examinations to evaluate the existence of
accompanying malignant tumors. Colonoscopy revealed
type 2 tumors in the rectum (Fig. 2a); the patient was
diagnosed with adenocarcinoma following a biopsy.
Computed tomography (CT) scan showed no distant
metastases and some swollen lymph nodes. We per-
formed anterior resection of the rectum and regional
lymphadenectomy. The pathological diagnosis was mod-
erately differentiated adenocarcinoma, T3N1M0, and
stage III according to the 7th edition of the International
Union Against Cancer TNM classification (Fig. 2b). DM
symptoms improved after surgery. The patient received
adjuvant chemotherapy of capecitabine for 6 months,
and blood examinations were performed every 3 months
during follow-up at the outpatient clinic. No evidence of
the recurrence in the tumor marker, CT scan, and colon-
oscopy were observed 1 year postoperatively. During this
period, he did not receive immunosuppressants such as
predonisolone.
One year and 9 months after surgery, he was referred
to the hospital due to exacerbated skin symptoms,
including heliotrope rash and Gottron’s papules. The
laboratory examination revealed elevated levels of creat-
ine kinase (671 U/l), aspartate transaminase (122 IU/l),
lactate dehydrogenase (525 IU/l), and carcinoembryonic
antigens (6.5 ng/ml). Based on these findings, we
suspected rectal cancer recurrence, and the CT scan
revealed a 30-mm tumor in the segment 7 of the liver
(Fig. 2c). There were no other distant metastases in the
gastrointestinal endoscopy and colonoscopy. The patient
was diagnosed with recurring rectal cancer, and he
underwent partial resection of the liver at segment 7.
Metastatic adenocarcinoma was confirmed in the histo-
pathological examination (Fig. 2d); postoperative course
was uneventful.
The patient’s skin symptoms improved postoperatively.
Laboratory values including CPK, aldolase, and CEA also
decreased. Capecitabine was administrated as an adju-
vant chemotherapy for 6 months. No evidence of cancer
recurrence and DM symptoms were observed 2 years
after the hepatectomy.
Discussion
The association between DM and malignant tumors was
independently described nearly 100 years ago by two
investigators, Kankeleit and Stertz [7]. The incidence of
cancer in adult patients with DM is approximately 13–
42% [8]. Although its underlying pathogenesis remains
unknown, it has been considered as one of the probable
reasons why paraneoplastic condition producing bio-
active mediators causes immune reactions in the muscle
fibers and skin [5, 9]. Patients with DM and malignant
disease have reportedly a worse prognosis than patients
with idiopathic DM; surgical resection was not possible
in many of the patients with cancer because of the
advanced stage of their disease [10]. Difficulties in the
management of cancer chemotherapy and medication
for DM symptoms have also been reported due to severe
dysphagia in patients with unresectable metastases [6].
Successful treatment of these malignancies can lead to
resolution of paraneoplastic symptoms. Several reports
have shown that tumor resection can lead to the reso-
lution of paraneoplastic DM symptoms [11]. In our case,
the extent of DM symptoms was associated with the
treatment course of rectal cancer, suggesting that we
Fig. 1 a Facial erythma and heliotrope rash. b Gottron’s papules overlying knuckles
Ono et al. Surgical Case Reports  (2017) 3:3 Page 2 of 4
were dealing with a case of paraneoplastic DM caused
by rectal cancer.
It has been reported that symptoms also worsen when
the malignancy recurred after resection of the primary
disease in patients with paraneoplastic DM. However, to
date, few reports have described details of recurring
disease in the patients with DM accompanied by colo-
rectal cancer. We have therefore investigated recurrent
cases of DM accompanied by colorectal cancer to clarify
the clinical features of these cases.
A literature search was conducted in April 2016 using
the PubMed and Ichushi database to obtain English and
Japanese literature describing recurring cases of patients
with colorectal cancer and DM; four reports were found
[6, 12–14].The keywords used in the search were “derm-
atomyositis” and “colorectal cancer.” The details of clini-
copathological features of these cases, including the
present case, are demonstrated in Table 1. There were
two men and three women with a mean age of 54 years.
Three patients had colon cancer and two had rectal can-
cer. Two cases had synchronous liver metastases, and
hepatic resections were performed after the resection of
the primary tumors. Recurrence sites were in the liver in
three cases, lung in two cases, and local recurrence in
one case (including overlapped case). Four reported
cases presented moderately differentiated adenocarcin-
oma; however, the pathological differences between
general colorectal cancers were not determined. The
molecular findings for such cases were not described,
although one case presented BRAF V600E mutation
(case 3). Further investigation is needed to clarify these
findings. DM symptoms worsened when cancer recurred
in four cases, except in one case that was not described
in detail. In the two cases including our case, cancer re-
lapses were detected by exacerbation of DM symptoms,
although these were not preceded by cancer relapses in
the other two cases. Cancer recurrence occurred within
3 to 7 months after surgery in all cases, except for the
case we present here. Systemic chemotherapies were ap-
plied in all four cases, and three of the four patients died
from disease. Based on these findings, patients with
paraneoplastic disease were suggested to have resistance
to surgery, although poor prognoses compared with
common colorectal cancer could not be determined
because of the small sample size. The present case dem-
onstrated good outcomes with resection of metastatic
disease and relatively long disease-free survival.
Most patients presented with exacerbating DM symp-
toms when the colorectal cancer relapsed. It is important
to check the exacerbation of DM symptoms, including
skin erythema and dysphagia, when following patients
with paraneoplastic DM. Few studies reported recurring
cases of DM and other cancers. These reports demon-
strated the association between DM symptoms and cancer
recurrence in patients with ovarian cancer [15], breast
cancer [16], and bladder cancer [17], supporting our
Fig. 2 a 4.7 cm × 4.6 cm-sized type 2 tumor in the rectosigmoid colon. b The pathological diagnosis was moderately differented
adenocarcinoma (HE staining). c CT scan revealed a 30-mm tumor in segment 7 of the liver. d Metastatic adenocarcinoma was confirmed in the
histopathological examination
Ono et al. Surgical Case Reports  (2017) 3:3 Page 3 of 4
findings in colorectal cancer. The present report describes
a rare case with a good outcome of resecting liver metas-
tases that were detected early by exacerbation of skin
symptoms before annual examination in a patient with
DM accompanied by rectal cancer.
Conclusions
In conclusion, patients with paraneoplastic DM generally
have poor prognoses with treatment resistance. How-
ever, the present report demonstrates that there are
several cases with good, long-term results with resection
of metastatic diseases. It is important to check for the
exacerbation of DM symptoms because this symptom
sometimes appears to precede cancer relapse in the
follow-up of patients with colorectal cancer and DM.
Abbreviations
CEA: Carcinoembryonic antigen; CT: Computed tomography;
DM: Dermatomyositis
Acknowledgements
None
Authors’ contributions
All authors participated in the operation or management of the patient in
this case report. KO and TT underwent the operation. KO and MS drafted
and revised the manuscript. TT is the chairperson of our department and
supervised the writing of the manuscript. All authors read and approved the
final manuscript.
Authors’ information
All authors are surgeons of the National Hospital Organization
Higashihiroshima Medical Center.
Competing interests
The authors declare that they have no competing interests.
Consent for publication
Written informed consent was obtained from the patient for the publication
of this case report and any accompanying images. A copy of the written
consent is available for review by the Editor-in-Chief of this journal.
Author details
1Department of Surgery, National Hospital Organization Higashihiroshima
Medical Center, 513, Jike, Saijyo-cho, Higashihiroshima, Hiroshima 739-0041,
Japan. 2Department of Gastroenterological and transplant Surgery, Applied
life sciences, Institute of Biomedical & Health sciences, Hiroshima University,
Hiroshima, Japan.
Received: 15 October 2016 Accepted: 20 December 2016
References
1. Zahr ZA, Baer AN. Malignancy in myositis. Curr Rheumatol Rep. 2011;13:208–15.
2. Zhang W, Jiang SP, Huang L. Dermatomyositis and malignancy: a
retrospective study of 115 cases. Eur Rev Med Pharmacol Sci. 2009;13:77–80.
3. Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts). N
Engl J Med. 1975;292(7):344–77.
4. Hill CL, Zhang Y, Sigurgeirsson B, Pukkala E, Mellemkjaer L, Airio A, et al.
Frequency of specific cancer types in dermatomyositis and polymyositis: a
population-based study. Lancet. 2001;357:96–100.
5. Andras C, Ponyi A, Constantin T, Csiki Z, Szekanecz E, Szodoray P, et al.
Dermatomyositis and polymyositis associated with malignancy: a 21-year
retrospective study. J Rheumatol. 2008;35:438–44.
6. Nagano Y, Inoue Y, Shimura T, Fujikawa H, Okugawa Y, Hiro J, et al.
Exacerbation of dermatomyositis with recurrence of rectal cancer: a case
report. Case Rep Oncol. 2015;8:482–6.
7. Przybylski G, Jarzemska A, Czerniak J, Siemiatkowska K, Gadzinska A,
Cieslinski K. A case report of a patient with dermatomyositis as a prodromal
sign of lung cancer. Pol Arch Med Wewn. 2008;118:143–7.
8. Zampieri S, Valente M, Adami N, Biral D, Ghirardello A, Rampudda ME, et al.
Polymyositis, dermatomyositis and malignancy: a further intriguing link.
Autoimmun Rev. 2010;9:449–53.
9. Wang J, Guo G, Chen G, Wu B, Lu L, Bao L. Meta-analysis of the association of
dermatomyositis and polymyositis with cancer. Br J Dermatol. 2013;169:838–47.
10. Wakata N, Kurihara T, Saito E, Kinoshita M. Polymyositis and dermatomyositis
associated with malignancy: a 30-year retrospective study. Int J Dermatol.
2002;41:729–34.
11. Leow YH, Goh CL. Malignancy in adult dermatomyositis. Int J Dermatol.
1997;36(12):904–7.
12. Landriscina M, Gerardi AM, Fersini A, Modoni S, Stoppino LP, Macarini L,
et al. Multiple skeletal muscle metastases from colon carcinoma preceded
by paraneoplastic dermatomyositis. Case Rep Med. 2013;2013:392609.
13. Ishii S, Ouchi A, Kawakami K, Shiiba K, Saitou Y, Matuno M. A case of
dermatomyositis with Dukes A rectal carcinoma which died of its local
recurrence 4 months after radical operation. J Jpn Surg Assoc. 1990;45(3):385–8.
14. Yamada K, Maeda T, Chisa T, Fukuda R, Nozaki H, Makizumi R, et al. A case
report of colon cancer with liver metastasis in patient with dermatomyositis.
J Jpn Soc Coloproctol. 1999;52:499–504.
15. Osako T, Ito Y, Morimatsu A, Tada K, Sakurai N, Takahashi S, et al. Flare-up of
dermatomyositis along with recurrence of breast cancer. Breast J. 2007;13(2):200–2.
16. Fitzpatrick J, Wallace WA, Lang S, Aboumarzouk OM, Windsor P, Nabi G.
Recurrent dermatomyositis manifesting as a sign of recurrent transitional cell
carcinoma of urinary bladder: long-term survival. Urol Ann. 2014;6(3):264–6.
17. Christie A, McKay N, Nussey F. Dermatomyositis as presenting feature of
ovarian cancer, treated with neo-adjuvant chemotherapy and interval
debulking surgery. Gynecol Oncol Case Rep. 2013;6:13–5.
Table 1 Reported cases
Case Author (year) Sex Age Location Stage Recurrence
site
Histological
type
Disease-free
interval
DM symptom related
to the recurrence
Treatment for
recurrent disease
Outcome (time
after recurrence)
1 Ishii S (1990) F 53 Rectum I Local Mod. 4 months Present Chemotherapy DOD (2 months)
2 Yamada K
(1999)
M 58 Colon IV Liver Mod. 3 months ND Chemotherapy DOD (2 years)
3 Landriscina M
(2013)
F 71 Colon IV Lung ND 7 months Present Chemotherapy DOD (ND)
4 Nagano Y
(2015)
F 44 Rectum II Lung and
liver
Mod. 4 months Present Chemotherapy Alive with disease
(7 months)
5 Present case
(2016)
M 42 Rectum III Liver Mod. 21 months Present Resection NED (2 years)
DM dermatomyositis, Mod. moderately differentiated adenocarcinoma, ND not described, DOD died of disease, NED no evidence of disease
Ono et al. Surgical Case Reports  (2017) 3:3 Page 4 of 4


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LETTER TO THE EDITOR Open Access
Neglected tropical diseases and global
burden of disease in China
Men-Bao Qian1,2,3,4
Abstract
Recently, the mortality of 240 causes in China including a subnational analysis during 1990–2013 was published in
The Lancet. This comprehensive analysis will undoubtedly impact policymaking regarding public health in China.
However, it is unfavourable in some degree to neglected tropical diseases, which is the subject of this Letter to the
Editor. Policymakers, especially those in less developed provinces of China, should fully consider the burden of
neglected tropical diseases, which will benefit the control and final elimination of these diseases in the country.
Keywords: China, Global burden of disease, Neglected tropical diseases
Multilingual abstracts
Please see Additional file 1 for translations of the
abstract into the six official working language of the
United Nations.
Background
Recently, Maigeng Zhou and colleagues released the
mortality of 240 causes in China, which included a sub-
national analysis during 1990–2013, in The Lancet [1].
This comprehensive analysis will undoubtedly impact
policymaking regarding public health in China. However,
the analysis is unfavourable to neglected tropical dis-
eases (NTDs). In Zhou’s article, the proportion of deaths
caused by NTDs in all mortality causes in China in 2013
was only 0.044% (4 015/9 144 285) and only 0.019%
(1 782/9 144 285) after excluding rabies (see Fig. 1) [1].
Although great achievements have been made in the
control of NTDs during the past half-century in China,
this recent report is likely to lead to the misconception
about the unimportance of NTDs in contemporary
China and subsequently to severe neglect in the control
of these diseases.
Why are these diseases neglected?
First, the inherent characteristics of NTDs determine
their low mortality and high disability. According to
Yang’s article on the Global Burden of Disease in China
in 2010, the proportion of deaths caused by NTDs in all
mortality causes was 0.178 and 0.164% after excluding
rabies, while the corresponding disability-adjusted life
years (DALYs) were 1.164 and 1.150%, respectively (see
Fig. 1) [2]. The mortality indicator constitutes only a
very small proportion of the life lost due to NTDs, as
most NTDs do not cause significant death but rather
chronic disability, which affects infected individuals as
well as the socio-economics of the country in general.
Second, data on NTDs are usually underestimated due
to inadequate reporting usually caused by the endemicity
of NTDs in poor rural areas as well as insufficient re-
search. For example, only 281 deaths caused by cystic
echinococcosis were estimated in 2013 [1]. However, al-
veolar echinococcosis is usually co-endemic in areas
with a presence of cystic echinococcosis. It was reported
that about 25% echinococcosis is alveolar in China [3].
Further consideration of the higher severity of alveolar
echinococcosis due to its progressive invasion, mortality
cases due to alveolar echinococcosis could not be
neglected. Another typical example is clonorchiasis.
Clonorchiasis is currently the most important food-
borne parasitic disease in China, but it was not classi-
fied as a definite carcinogen of cholangiocarcinoma
until 2009 [4–6]. It is estimated that over 4 000
new cholangiocarcinoma cases are attributed to
Correspondence: ahtlqmb-007@163.com
1Key Laboratory on Biology of Parasite and Vector, Ministry of Health,
Shanghai 200025, China
2National Center for International Research on Tropical Diseases, Shanghai
200025, China
3WHO Collaborating Center for Tropical Diseases, Shanghai, China
4National Institute of Parasitic Diseases, Chinese Center for Disease Control
and Prevention, Shanghai 200025, China
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Qian Infectious Diseases of Poverty  (2017) 6:25 
DOI 10.1186/s40249-017-0237-y
Clonorchis sinensis infection globally each year, about
85% of which occur in China [4]. Taking into account the
high mortality of cholangiocarcinoma, the mortality due
to C. sinensis infection is also likely to be significant.
Third, endemicity is also one typical characteristic of
most NTDs. As demonstrated in Zhou’s article, the dis-
tribution of NTDs varies significantly at the provincial
level and this imbalance in distribution also exists at the
sub-provincial level. NTDs impact people in rural areas,
especially in western China, who are affected by a com-
bination of the presence of NTDs, poverty and inad-
equate medical services [7]. Thus, in a view of average
level ignores the importance of NTDs in special areas.
Finally, it is important for interventions to be highly
cost-effective at all times. Due to definite causes and ef-
fective interventions, control of NTDs always returns sub-
stantially, especially through integrated control packages.
Suggestions
The control of NTDs is formally included in the Sustain-
able Development Goals [8]. Goal 3 aims to “ensure
healthy lives and promote well-being for all at all ages”.
Item 3 of Goal 3 stipulates ending the epidemics of NTDs
by 2030, as well as of AIDS, tuberculosis and malaria.
Thus, policymakers in China, especially in less developed
provinces, should fully consider the burden of NTDs, in-
cluding the associated high disability, low mortality, serious
underreporting, and severe imbalance in their distribution
and high cost-effectiveness in control. Furthermore, more
research on NTDs is required, especially the establishment
of a comprehensive database, which will ensure a more ac-
curate evaluation of the burden of NTDs in China [9].
Additional file
Additional file 1: Multilingual abstracts in the six officila working
languages of the United Nations. (PDF 661 kb)
Abbreviations
DALYs: Disability-adjusted life years; NTDs: Neglected tropical diseases
Acknowledgements
Not applicable.
Funding
MBQ was financially supported by the Fourth Round of Three-Year Public
Health Action Plan (2015–2017) in Shanghai (grant No. GWTD2015S06). The
funder had no role in study design, data collection and analysis, decision to
publish, or preparation of the manuscript.
Availability of data and materials
Data sharing not applicable as no datasets were generated or analysed for
this paper.
Author’s contribution
MBQ conceived the idea, and prepared and drafted the paper.
Competing interests
The author declares that he has no competing interests.
Consent for publication
Not applicable.
Ethics approval and consent to participate
Not applicable.
Received: 30 March 2016 Accepted: 6 January 2017
References
1. Zhou M, Wang H, Zhu J, Chen W, Wang L, Liu S, et al. Cause-specific
mortality for 240 causes in China during 1990-2013: a systematic
subnational analysis for the global burden of disease study 2013. Lancet.
2016;387(10015):251–72. doi:10.1016/S0140-6736(15)00551-6.
2. Yang G, Wang Y, Zeng Y, Gao GF, Liang X, Zhou M, et al. Rapid health
transition in China, 1990-2010: findings from the global burden of
disease study 2010. Lancet. 2013;381(9882):1987–2015. doi:10.1016/
S0140-6736(13)61097-1.
3. Technical Steering Panel for National Survey of Current Status of Major
Human Parasitic Diseases. Report on the national survey of current status of
major human parasitic diseases in China. Beijing: People’s Medical
Publishing House; 2008. in Chinese.
4. Qian MB, Chen YD, Liang S, Yang GJ, Zhou XN. The global epidemiology of
clonorchiasis and its relation with cholangiocarcinoma. Infect Dis Poverty.
2012;1(1):4. doi:10.1186/2049-9957-1-4.
5. Qian MB, Chen YD, Yan F. Time to tackle clonorchiasis in China. Infect Dis
Poverty. 2013;2(1):4. doi:10.1186/2049-9957-2-4.
6. Qian MB, Utzinger J, Keiser J, Zhou XN. Clonorchiasis Lancet. 2016;
387(10020):800–10. doi:10.1016/S0140-6736(15)60313-0.
7. Yang GJ, Liu L, Zhu HR, Griffiths SM, Tanner M, Bergquist R, et al. China’s
sustained drive to eliminate neglected tropical diseases. Lancet Infect Dis.
2014;14(9):881–92. doi:10.1016/S1473-3099(14)70727-3.
8. United Nations. Sustainable development goals. http://www.un.org/
sustainabledevelopment/ Accessed 28 Mar 2016.
9. Qian MB, Zhou XN. Global burden on neglected tropical diseases. Lancet
Infect Dis. 2016;16(10):1113–4. doi:10.1016/S1473-3099(16)30328-0.
Fig. 1 Proportion of NTDs in all causes in China by death
and DALYs
Qian Infectious Diseases of Poverty  (2017) 6:25 Page 2 of 2


Neglected tropical diseases and global burden of disease in China

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