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BackgroundParaneoplastic syndromes (PNSs) are common complications of lung cancer and often develop preceding the diagnosis of primary malignancy. Rheumatologic PNSs mimicking Adult-Onset Still' s Disease (AOSD) is a rare condition with only a limited number of cases reported in the literature, none of which was associated with lung cancer. It is often difficult to differentiate AOSD-like paraneoplasia from coincidental AOSD based on the clinical manifestations.Case presentationHere we present a 56-year-old man with advanced lung adenocarcinoma who developed a remittent fever together with pharyngodynia and joint pain after first cycle of chemotherapy with paclitaxel plus carboplatin. Although a leukocytosis was detected, no evidence of infection was acquired and empirical antibiotic treatment was ineffective. A temple skin rash, abnormal hepatic function and a remarkable elevated level of serum ferritin occurred later in this patient, which highly supported a potential diagnosis of AOSD. The patient was finally diagnosed as AOSD-like PNS considering the good and prompt response to a short-term administration of non-steroidal anti-inflammatory drug and subsequent cycles of effective chemotherapy with pemetrexed plus cisplatin.Discussion and conclusionsThough rare, AOSD-like PNS can be one of the potential diagnoses in lung cancer patients with fever of undetermined origin, especially those having no response to antibiotic treatment. Management consists of control of the underlying malignancy and symptomatic treatment of the syndromes with non-steroidal anti-inflammatory drugs or corticosteroids.

Rhabdomyosarcoma (RMS) is one of the most common soft tissue sarcomas of adolescents and young adults. Histologically, rhabdomyosarcoma is classified into embryonal, alveolar, pleomorphic, and spindle cell/sclerosing rhabdomyosarcomas with further subcategorization. More than 50% of embryonal rhabdomyosarcoma occur within head and neck. The retroperitoneum and pelvis are less common sites of involvement. Embryonal rhabdomyosarcomas affect mainly, but not exclusively, children between birth and 15 years of age. Alveolar rhabdomyosarcoma tends to affect older patients. The usual metastatic sites include lung, lymph nodes, and bone marrow. We are presenting a case of a 25-year-old male patient with symptoms of breathlessness, easy fatigability, and weight loss. On chest imaging, there were multiple lung nodules. A primary diagnosis of undifferentiated malignant neoplasm was made on lung biopsy. On immunohistochemistry, the malignant cells were positive for myogenin, myoblast determination protein 1 (MyoD1), and desmin. They were negative for neuroendocrine, germ cell, epithelial, melanocytic, and lymphoid markers. Further workup showed an abdominopelvic retroperitoneal mass on abdominal computed tomography (CT) scan. The biopsy on the retroperitoneal mass showed similar morphology and immunohistochemical profile. Unfortunately, the patient's condition deteriorated rapidly in the following weeks, and he passed away.

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