Vasculitis and Breast Cancer: Mind the Hint

Area of Science:

• Oncology
• Rheumatology
• Pulmonology

Background:

• Breast cancer, particularly papillary ductal carcinoma, can present with rare paraneoplastic syndromes.
• Anti-neutrophil cytoplasmic antibody (ANCA)-associated small vessel vasculitis is a systemic autoimmune disease.
• Diffuse alveolar hemorrhage (DAH) is a critical pulmonary manifestation of vasculitis.

Observation:

• A 77-year-old woman with breast cancer presented with DAH.
• The DAH was diagnosed as secondary to perinuclear ANCA-associated vasculitis.
• This represents a unique paraneoplastic presentation of breast cancer.

Findings:

• The case highlights the first documented instance of DAH secondary to ANCA-associated vasculitis as a presenting sign of breast cancer.
• The paraneoplastic vasculitis was treated with corticosteroids and plasmapheresis.
• Plasmapheresis was used to remove circulating antibodies, aiming to stabilize the patient while considering definitive cancer treatment.

Implications:

• This case expands the spectrum of paraneoplastic syndromes associated with breast cancer.
• It underscores the importance of considering systemic vasculitis in patients with unexplained DAH, especially those with malignancy.
• Early recognition and multidisciplinary management are crucial for improving outcomes in such rare presentations.