Cutaneous Manifestations of Relapsing Polychondritis in a Patient Receiving Goserelin for Carcinoma of the Prostate

Abstract

Relapsing polychondritis is a chronic rheumatologic disorder of unknown etiology. Cutaneous manifestations occur in nearly half of the patients and often precede cartilaginous involvement. We present the case of a man with a history of prostatic adenocarcinoma who underwent monthly injections of goserelin (Zoladex®), an LH-RH analogue. Five months after the beginning of the treatment, he presented cutaneous manifestations, which then recurred monthly, after each goserelin injection. After goserelin interruption and replacement with another treatment (cyproterone acetate), the patient was asymptomatic for 2 months. A cutaneous relapse then occurred followed by a typical cartilaginous involvement. In our observation, goserelin seems to have triggered the cutaneous manifestations of relapsing polychondritis. An hormonal precipitating factor in relapsing polychondritis has already been suggested by reports of patients whose disease worsened under chorionic gonadotropin treatment or during pregnancy.

Sweet's syndrome and relapsing polychondritis: Is their appearance in the same patient a coincidental occurrence or a bona fide association of these conditions?

“…Relapsing polychondritis can be associated with connective tissue diseases (ankylosing spondylitis, psoriatic arthritis, Reiter's syndrome, rheumatoid arthritis, Sjogren's syndrome, systemic lupus erythematosus), gastrointestinal diseases (Crohn's disease, primary biliary cirrhosis, and ulcerative colitis), endocrine disorders (diabetes mellitus type I, Graves’ disease, Hashimoto thyroiditis, and hypothyroidism), and systemic vasculitides (such as Behcet's disease/MAGIC [mouth and genital ulcers with inflamed cartilage] syndrome, Churg–Strauss syndrome, microscopic polyarteritis, polyarteritis nodosa, Takayasu arteritis, and temporal arteritis) 27–35 . Paraneoplastic relapsing polychondritis is increasingly being described: Most commonly in patients with myelodysplastic syndrome, 30,31,36–48 but also – less frequently – in individuals with other malignant hematologic disorders 28,30,32,45–47,49–54 or solid tumors 1,30,47,55–60 . Rarely benign neoplasms (thymoma in an individual with myasthenia gravis 61 and enchondroma 62 have been reported in relapsing polychondritis patients.…”

“…A comparison of the epidemiology, clinical and histologic features, treatment, and pathogenesis of Sweet's syndrome and relapsing polychondritis is summarized in Table 1 1,12–73 . In a series of 48 patients with Sweet's syndrome, 6.25% of the individuals (three patients) had relapsing polychondritis 65 .…”

“… † Data for this table has been summarized from several reports: Sweet's syndrome 1–26,36,37,63–73 and relapsing polychondritis 1,27–65 …”

“… ††† Some of the solid tumors reported in patients with relapsing polychondritis include: Adenocarcinoma (unknown primary), 47 bladder, 1 breast, 30 bronchus, 47 chondrosarcoma, 58 colon, 30,57 lung, 30 malignant fibrohistiocytoma, 57 pancreas, 56 prostate, 56,59 rectum, 60 and vocal cords 57 …”

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“…There is probably a common trigger that links the two diseases. The autoimmune basis is more and more raised, but it part in the pathogenesis of paraneoplastic RP has not yet been obvious [13,[31][32][33][34]. Of note, treatment may induce remission of the two diseases.…”