Keywords: Carcinoma; paraneoplastic; subacute cutaneous lupus erythematosus
On physical examination, nonscaly erythematous
maculopapular and plaques, annular and photo-distributed
eruptions involving the face, scalp, forearm,
and dorsal of the hands were found. Non-scarring hair
loss on the scalp and a decrease in the eyebrows and
eyelashes were seen (Fig.
Histological examination of a skin biopsy found
epidermal atrophy, vacuolar degeneration in the
basal layer, basement-membrane thickening, superficial
perivascular lymphocytic infiltration, and a mild
chronic inflammatory infiltrate periadnexally and
along the dermoepidermal junction, consistent with
subacute cutaneous lupus erythematosus (SCLE) (Figs.
Full blood count, urea, and electrolytes were within normal limits. Liver transaminases, bilirubin, and alkaline phosphatase were normal. There was no blood or protein in the urine. CT of the abdomen and pelvis were normal. Lymphadenopathies showing increased metabolism in the left axilla were evaluated by the PET method.
The biopsy results in combination with the clinical presentation, physical exam findings, and serologic markers established the diagnosis of SCLE associated with breast carcinoma.
It was initially thought that the patient"s SCLE may have been drug induced, but this is unlikely in light of her breast cancer diagnosis and the lack of a temporal relationship between the onset of the rash and her therapeutic drug regimen. Her skin lesions had started approximately one month before the initation of the chemotherapy treatment. Hence, it was not considered a drug-induced skin finding.
Therefore, the coexistence of these two diseases should not be considered as coincidence as it may herald an underlying malignancy in its early stages.
Punch biopsy was performed after the clinical evaluation
of the patient and low-potency topical steroid therapy was initiated for twice. During the patient"s
control examination in her third week, the SCLE lesion
was partially regressed. Particularly, the erythema on
her face was reduced and the plaques were thinning
(Fig.
Paraneoplastic symptoms can be the first indication
of an underlying malignancy. As many as 15% of
patients diagnosed with a cancer have a concomitant
paraneoplastic process at the time of diagnosis.[
An association between an internal malignancy and
SCLE was reported in the literature since the 1980"s.
Lung, breast, head & neck, gastric, liver, prostate, hepatocellular,
laryngeal carcinoma, uterine, and esophageal
adenocarcinoma and Hodgkin's lymphoma association
with SCLE have been documented.[
A small number of SCLE cases associated with
breast carcinoma hs been revealed in the literature.[
For a dermatosis to be considered as paraneoplastic,
it must occur simultaneously with malignancy, should
have a parallel course with the malignancy, and regress
with the treatment applied for cancer. The treatment
of our patient continues in the oncology department.
We thought that the improvement observed in the skin
lesions might be due to the patient's chemotherapy and
we planned to follow-up the patient for skin lesions for
a while to confirm these lesions as paraneoplastic.
Informed consent: Written informed consent was obtained from the patient for the publication of the case report and the accompanying images.
Peer-review: Externally peer-reviewed.
Conflict of Interest: No conflict of interest to declare.
Financial Disclosure: No funding was received.
Authorship contributions: Concept - S.B.D.; Design - S.B.D.; Supervision - S.B.D.; Materials - S.B.D.; Data collection &/or processing - S.B.D.; Analysis and/or interpretation - S.B.D, B.Y., A.K.; Literature search - S.B.D. Ö.A.S., P.K.; Writing - S.B.D., B.Y., A.K.; Critical review - S.B.D., B.Y., A.K.
