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Digital necrosis as a paraneoplastic syndrome
C A Peschken1, S L Walker, H S El-Gabalawy
1Rheumatic Disease Unit, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
Summary
Sudden digital necrosis and ulceration in a patient with high antinuclear antibodies and vasculitis were linked to small cell lung cancer. Promptly investigate unexplained digital necrosis for potential malignancy.
Area of Science:
- Oncology
- Rheumatology
- Dermatology
Background:
- Digital ulceration and necrosis can be associated with malignancy.
- Antinuclear antibodies and cutaneous vasculitis are also independently linked to various conditions.
- The simultaneous occurrence of these findings with cancer is rare.
Purpose of the Study:
- To report a unique case of digital necrosis, vasculitis, and high antinuclear antibodies in a patient with small cell lung cancer.
- To review the literature on digital necrosis as a paraneoplastic syndrome.
- To discuss potential mechanisms and the implications for cancer diagnosis.
Main Methods:
- Case report of a 62-year-old woman.
- Clinical examination and laboratory investigations including antinuclear antibody titers.
- Review of existing medical literature on digital necrosis and paraneoplastic syndromes.
Main Results:
- The patient presented with sudden digital ulceration and necrosis, high antinuclear antibody titers, and cutaneous vasculitis.
- Small cell lung cancer was diagnosed.
- Digital lesions improved significantly with treatment of the lung tumor, while vasculitis treatment was ineffective.
Conclusions:
- This case highlights a rare paraneoplastic syndrome involving digital necrosis, vasculitis, and antinuclear antibodies associated with lung cancer.
- Unexplained digital necrosis should raise suspicion for an underlying malignancy.
- A systemic vasculitis related to tumor antigens is the likely mechanism.
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