1
|
Madabhavi I, Revannasiddaiah S, Rastogi M, Gupta MK. Paraneoplastic Raynaud's phenomenon manifesting before the diagnosis of lung cancer. BMJ Case Rep 2012; 2012:bcr0320125985. [PMID: 22761213 PMCID: PMC3391388 DOI: 10.1136/bcr.03.2012.5985] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This description pertains to a previously healthy gentleman aged 54 years who developed symptoms coherent with Raynaud's phenomenon. The patient never had any prior episodes of peripheral cyanosis. The patient's first presentation was in summer and the paroxysms of peripheral cyanosis were not associated with any specific aggravating factor. The paroxysms went on to become more severe and painful across a span of 6 months, when he also developed non-radiating pain in the right lateral chest-wall, which would aggravate after episodes of cough. A chest roentgenogram then demonstrated the presence of a mass lesion in the right lung and a fine-needle-aspiration cytology confirmed malignancy- an adenocarcinoma. There was a dramatic relief in pain and a reduction in the intensity and duration of paroxysms of peripheral cyanosis within 2-weeks of initiation of chemotherapy for lung cancer.
Collapse
Affiliation(s)
- Irappa Madabhavi
- Department of Internal Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Swaroop Revannasiddaiah
- Department of Radiation Therapy and oncology, Regional Cancer Center, Indira Gandhi Medical College, Shima, India
| | - Madhup Rastogi
- Regional Cancer Centre, Indira Gandhi Medical College, Shimla, India
| | - Manoj Kumar Gupta
- Regional Cancer Centre, Indira Gandhi Medical College, Shimla, India
| |
Collapse
|
2
|
Madabhavi I, Revannasiddaiah S, Rastogi M, Gupta MK. Paraneoplastic Raynaud's phenomenon manifesting before the diagnosis of lung cancer. BMJ Case Rep 2012. [PMID: 22761213 DOI: 10.1136/bcr.03.2012.5985.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This description pertains to a previously healthy gentleman aged 54 years who developed symptoms coherent with Raynaud's phenomenon. The patient never had any prior episodes of peripheral cyanosis. The patient's first presentation was in summer and the paroxysms of peripheral cyanosis were not associated with any specific aggravating factor. The paroxysms went on to become more severe and painful across a span of 6 months, when he also developed non-radiating pain in the right lateral chest-wall, which would aggravate after episodes of cough. A chest roentgenogram then demonstrated the presence of a mass lesion in the right lung and a fine-needle-aspiration cytology confirmed malignancy- an adenocarcinoma. There was a dramatic relief in pain and a reduction in the intensity and duration of paroxysms of peripheral cyanosis within 2-weeks of initiation of chemotherapy for lung cancer.
Collapse
Affiliation(s)
- Irappa Madabhavi
- Department of Internal Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | | | | | | |
Collapse
|
3
|
Cruz C, Rocha M, Andrade D, Guimarães F, Silva V, Souza S, Moura C, Moura C. Hypertrophic pulmonary osteoarthropathy with positive antinuclear antibodies: case report. Case Rep Oncol 2012; 5:308-12. [PMID: 22740821 PMCID: PMC3383253 DOI: 10.1159/000339571] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A male Afro-descendant patient, 57 years old, complaining of polyarticular involvement and weight loss for 18 months, with a load of 13.5 pack years of smoking. On physical examination there was pain on palpation of the right knee and right leg, with signs of inflammation on the knee. We also observed digital clubbing in all fingers. Antinuclear antibodies (ANA) and anti-Sm antibodies were positive. X-rays of the legs and arm showed cortical thickening of long bones. The computed tomography demonstrated a large mass located in the middle lobe of the right lung. The anatomopathological study revealed a bronchial adenocarcinoma. The history of polyarticular involvement associated with positive anti-Sm and ANA antibodies could lead to an erroneous diagnosis of systemic lupus erythematosus. Considering the bad consequences of delayed diagnosis in this patient, the medical team should be alerted for suspecting and look for a lung cancer under these circumstances.
Collapse
Affiliation(s)
- C. Cruz
- Hospital Santo Antonio, Obras Sociais Irmã Dulce, Salvador, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
4
|
|
5
|
Grossman A, Gafter-Gvili A, Green H, Ben Aharon I, Stemmer SM, Molad Y, Krause I. Severe digital ischemia–a presenting symptom of malignancy–associated antiphospholipid syndrome. Lupus 2008; 17:206-9. [DOI: 10.1177/0961203307086235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The association of the antiphospholipid syndrome with malignancy has been extensively reported. Raynaud’s phenomenon has also been reported to be associated with various malignancies. In this report, we describe two patients who presented with severe digital ischemia mimicking Raynaud’s phenomenon. The patients were found to have antiphospholipid syndrome, and upon extensive evaluation, a diagnosis of a malignancy was made. This report highlights the importance of malignancy workup in patients with severe digital ischemia associated with antiphospholipid syndrome.
Collapse
Affiliation(s)
- A Grossman
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Campus, Petach Tikva Israel. Affiliated to Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - A Gafter-Gvili
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Campus, Petach Tikva Israel. Affiliated to Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - H Green
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Campus, Petach Tikva Israel. Affiliated to Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - I Ben Aharon
- Davidoff Comprehensive Cancer Center, Rabin Medical Center, Beilinson Campus, Petach Tikva Israel. Affiliated to Sackler Faculty of Medicine School, Tel Aviv University, Tel Aviv, Israel
| | - SM Stemmer
- Davidoff Comprehensive Cancer Center, Rabin Medical Center, Beilinson Campus, Petach Tikva Israel. Affiliated to Sackler Faculty of Medicine School, Tel Aviv University, Tel Aviv, Israel
| | - Y Molad
- Unit of Rheumatology, Rabin Medical Center, Beilinson Campus, Petach Tikva Israel. Affiliated to Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - I Krause
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Campus, Petach Tikva Israel. Affiliated to Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
6
|
|
7
|
Poszepczynska-Guigné E, Viguier M, Chosidow O, Orcel B, Emmerich J, Dubertret L. Paraneoplastic acral vascular syndrome: epidemiologic features, clinical manifestations, and disease sequelae. J Am Acad Dermatol 2002; 47:47-52. [PMID: 12077580 DOI: 10.1067/mjd.2002.120474] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Acral vascular syndromes associated with malignancy have rarely been reported. OBJECTIVE Our purpose was to assess the clinical and evolving features of paraneoplastic acral vascular syndromes. PATIENTS AND METHODS Two cases of paraneoplastic gangrene are described and analyzed together with previously reported cases identified by a MEDLINE search. RESULTS Among the 68 patients identified, 40 had gangrene, 16 had acrocyanosis, and 12 had Raynaud's phenomenon. The male to female ratio was 0.89; median age was 59 years. Fingers were affected in 94%. Adenocarcinomas were the predominant associated malignancies (41%), and metastases were observed in 41%. The acral vascular syndromes in 48% of the patients definitively regressed after tumor treatment. Forty-four percent of the patients died within 2 years. A favorable cutaneous outcome was obtained with prostacyclin infusions in 6 patients. CONCLUSION A neoplastic origin of acral vascular syndrome should be considered in elderly patients, especially men, in the absence of usual causative conditions.
Collapse
Affiliation(s)
- Ewa Poszepczynska-Guigné
- Department of Dermatology, Hôpital Saint-Louis, 1 avenue Claude-Vellefaux, 75475 Paris Cedex 10, France
| | | | | | | | | | | |
Collapse
|
8
|
Chow SF, McKenna CH. Ovarian cancer and gangrene of the digits: case report and review of the literature. Mayo Clin Proc 1996; 71:253-8. [PMID: 8594283 DOI: 10.4065/71.3.253] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Digital ischemia has been reported with various types of cancer, especially gastrointestinal. It is more common in elderly women than in any other group, and the most common symptom is a gangrenous finger (or fingers). More than half of the patients have metastatic involvement. Once the primary disease has been treated, when feasible, the digital symptoms usually regress or disappear. The presence of digital ischemia without other rheumatologic stigmata or vascular predisposition in an elderly patient should raise clinical suspicion of a paraneoplastic phenomenon. Herein we describe a 65-year old woman with digital ischemia associated with ovarian cancer. The diagnosis was established by biopsy after extremely high levels of cancer antigen 125 were detected.
Collapse
Affiliation(s)
- S F Chow
- Division of Rheumatology and Internal Medicine, Mayo Clinic Rochester, Rochester, Minnesota 55905, USA
| | | |
Collapse
|
9
|
Zuber M, Miesel R, Brandl B. A patient with a high titer of antinuclear antibody and a functioning adrenal tumour. Clin Rheumatol 1995; 14:100-3. [PMID: 7743733 DOI: 10.1007/bf02208093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Reported is the case of a 60-year-old female who was referred to our rheumatology center because of a high titer of antinuclear antibodies (ANAs). Initially several lupus-like features suggested a diagnosis of undifferentiated connective tissue disease (UCTD). Immunofluorescence of the patient's serum showed a nuclear dot pattern. Counterimmunoelectrophoresis for antibodies to Sm, RNP, SS-A and SS-B were negative. Immunoblotting revealed a band at 53 kD which did not correspond to known autoantigens. Several months later the patient presented to the emergency room with symptoms due to a hypertensive crisis. Check-up finally revealed a cortisone-producing tumour of the right adrenal gland. The adenoma was removed by surgery and the patient did well again.
Collapse
Affiliation(s)
- M Zuber
- German Research Center for Rheumatology, Berlin
| | | | | |
Collapse
|
10
|
Abstract
A retrospective survey of all patients with a positive anticentromere antibody (ACA) determination was undertaken over a 3-years period of time in a university hospital. Forty-five patients were positive for anticentromere antibodies. The analysis of the clinical characteristics and diagnoses of the patients with anticentromere antibodies were correlated and showed a diverse array of symptoms. Only 4.4% had CREST syndrome, 6.7% had limited scleroderma, 17.8% had diffuse scleroderma, 20% had other connective tissue diseases, 20% had other miscellaneous rheumatic conditions, 11.1% had tumours and 20% other nonrheumatic diseases. The study shows that the presence of ACA, as detected during routine ANA-testing, does not strongly suggest a diagnosis of CREST at that time. The presence of a scleroderma-variant in almost 50% of the patients and the occurrence of Raynaud's phenomenon in 62% underscores, however, an association of ACA with (early) scleroderma-like disorders.
Collapse
Affiliation(s)
- M Zuber
- German Research Center for Rheumatology, Berlin
| | | | | |
Collapse
|
11
|
Abstract
Paraneoplastic syndromes are rare in paediatric oncology. This report describes a four-year-old Cantonese child whose sole presenting symptom was acrocyanosis who was found to have Burkitt's lymphoma in association with the presence of positive antinuclear antibodies, antineutrophil cytoplasmic antibodies, antiendothelial antibodies and elevated serum immunoglobulin G concentrations. Digital ischaemia has not been described as a presenting symptom of Burkitt's lymphoma, although this association has been reported in 25 patients with other malignancies.
Collapse
Affiliation(s)
- P Smith
- Department of Paediatrics and Oncology, Adelaide Medical Centre for Women and Children, South Australia
| | | | | | | | | |
Collapse
|
12
|
|
13
|
Olivieri I, Genovesi-Ebert F, Signorini G, Pasero G. Conjunctival ulceration in Behçet's syndrome. Ann Rheum Dis 1992; 51:574-5. [PMID: 1586269 PMCID: PMC1004724 DOI: 10.1136/ard.51.4.574] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
14
|
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 50-1991. A 71-year-old woman with a sensorimotor neuropathy and radiographically demonstrable abnormalities. N Engl J Med 1991; 325:1723-35. [PMID: 1658653 DOI: 10.1056/nejm199112123252408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|