Development of multiple malignancies after immunosuppression in a patient with Wegener's granulomatosis

We describe the development of multiple malignancies in a patient with Wegener's granulomatosis treated with glucocorticosteroids, azathioprin and cyclophosphamide over 20 years. His symptoms started with a neurological disease, which is unusual. Less attention was paid to other symptoms that occurred simultaneously and were more typical manifestations of the disease. This resulted in delayed diagnosis. Despite incorrect diagnoses, he received appropriate immunosuppressive therapy. After 2 years of therapy, he developed a spinocellular carcinoma, after 12 years a basal cell carcinoma and after 19 years both a Kaposi sarcoma and a urinary bladder carcinoma. This patient illustrates a difficult therapeutic balance between prolonged treatment and the hazards of therapy. No guidelines are established to manage this clinical dilemma.