Recurrent metastatic breast cancer presenting with paraneoplastic scleroderma

A 44-year-old woman presented to the rheumatology clinic with a 5-month history of stiffness and tightness of the skin of the distal fingers, together with pruritus and skin changes throughout the limbs and chest. She had also developed Raynaud's phenomenon (during the summer months), fatigue and abdominal discomfort with early satiety. She had a history of adenocarcinoma of the left breast and had undergone a wide local excision and axillary node clearance 11 years earlier with adjuvant chemotherapy and hormone therapy to which she had responded well. She was found to have sclerodactyly with skin thickening over the knees, upper arms, face and chest wall together with nodularity at the scar site and distortion of the left breast. Subsequent investigations revealed recurrent metastatic breast cancer with paraneoplastic scleroderma. We explore this interesting case and review our current understanding of paraneoplastic scleroderma.