Inflammatory Breast Cancer and Warm Antibody Autoimmune Hemolytic Anemia: A Rare Paraneoplastic Syndrome

Abstract

Autoimmune hemolytic anemia (AIHA) is a disease process that involves the destruction of red blood cells mediated by the humoral immune system. It can be characterized as a cold agglutinin syndrome, paroxysmal cold hemoglobinuria, and warm, mixed type, and drug-induced AIHA. Although a well-established relationship exists between the presence of AIHA and lymphoproliferative malignancy, AIHA rarely presents in association with solid malignancies. An analysis of the limited number of published cases of AIHA in association with solid malignancies performed showed that AIHA may present before the diagnosis of a solid malignancy, concurrently with the presence of a solid malignancy, or even on resolution of a solid malignancy. Few cases of solid cancers associated with AIHA have been reported. AIHA rarely presents as a paraneoplastic syndrome indicating existence of a solid cancer. We report a case of inflammatory breast cancer with AIHA.

ACVIM consensus statement on the diagnosis of immune‐mediated hemolytic anemia in dogs and cats

“…Immune‐mediated hemolytic anemia is a recognized paraneoplastic syndrome in people . Chronic lymphocytic leukemia is a well‐established cause of IMHA in people .…”

“…Chronic lymphocytic leukemia is a well‐established cause of IMHA in people . Other neoplasms have been associated with IMHA in humans, but the causal mechanisms remain elusive . The IME values could be calculated for 13 studies (Figure ).…”

Autoimmune haemolytic anaemia in pancreatic adenocarcinoma: a potential paraneoplastic presentation

“…First-line therapy of AIHA usually consists of corticosteroid with varying results 14. However, most patients require undergoing therapy for the underlying malignancy to effectively observe improvement of haemoglobin 15. In our report, improvement of haemoglobin was obtained after chemotherapy for pancreatic cancer.…”

Pembrolizumab-associated autoimmune haemolytic anaemia

“…It is possible that in our case, AIHA was secondary to the malignancy rather than the immunotherapy, pembrolizumab. However, clinically this did not appear to be likely, as there had been no significant change in his burden of malignancy and case reports of AIHA and solid tumour malignancy appear to be correlated with tumour burden (either initially presenting with AIHA, which then improves/resolves with the treatment of the new underlying malignancy or progression of metastatic malignant disease with subsequent development of AIHA) 15 18–21. Furthermore, our patient had complete resolution of AIHA with steroid treatment and withdrawal of immunotherapy with no relapse on subsequent disease progression.…”