Diagnostic Dilemma of Paraneoplastic Rheumatic Disorders: Case Series and Narrative Review

Abstract

Paraneoplastic rheumatic disorder (RD) is a disorder that may present before, concurrent with, or after the diagnosis of malignancy. Paraneoplastic RDs are a clinical expression of occult cancer that is not directly related to a tumor or metastasis and manifests as rheumatoid symptoms. The RD is determined by the organ system affected by articular, muscular, cutaneous, vascular, or miscellaneous symptoms. Each case is challenging to diagnose because cancer may present with similar symptoms as a common rheumatic disorder. Of note, the majority of cases have minimal responsiveness or no responsiveness to standard rheumatoid treatment. Therefore, it is imperative to recognize and treat the underlying cancer accordingly. Herein, we present four different diagnostic dilemma cases of RD: case #1 -leukocytoclastic vasculitis and C3 glomerulopathy, case #2 -scleroderma, case #3 -Raynaud's syndrome and possible lupus-like syndrome, and case #4 -inflammatory myositis. Institutional IRB approval was obtained for this case series. We will discuss and review the literature on each topic. In addition, we will mention a review of paraneoplastic rheumatoid arthritis. As rheumatic disease is associated with the use of immune checkpoint inhibitors (ICIs) for cancer treatment, we will briefly discuss some of the most common rheumatic presentations in the setting of these drugs. This case review aims to inform clinicians about the atypical presentation of paraneoplastic RD and to highlight the need for interdisciplinary management between rheumatologists, oncologists, and primary care practitioners.

Síndromes paraneoplásicos reumatológicos: Presentación de dos casos clínicos y revisión de la bibliografía

“…Sin embargo, en la mayoría de casos es anterior al diagnóstico. 8,9 En un estudio prospectivo de Solans-Laque, 15 pacientes con diagnóstico de vasculitis y tumor sólido fueron seguidos durante 12 meses. Se describió vasculitis leucocitoclástica cutánea en el 60%, arteritis de células gigantes en el 20%, púrpura de Henoch-Shonlein en el 13% y poliarteritis nodosa en el 7% de los pacientes.…”

Systemic Sclerosis and Malignancy: Unravelling the Link through a Paraneoplastic Systemic Sclerosis Case Series

“…is often ineffective, but treatment of the underlying malignancy may improve the rheumatic symptoms. Recurrence of paraneoplastic symptoms with tumor recurrence is common [19].…”