Paraneoplastic polymyositis associated with a renal carcinoma

A 56-year-old patient was admitted to hospital because of difficulties in swallowing and in opening his mouth. The serological transaminases were increased. Over the next 6 weeks a bioptically proven polymyositis (more proximally located) caused a respiratory insufficiency which had to be treated by artificial respiration. A tetraplegia connected with a large increase of creatine-kinase was also seen. The general investigations were focused on malign processes with a particular search for bronchial carcinoma. At first a kidney cyst detected by ultrasound but was classified as harmless by several investigators. Finally, a computer tomogram of the abdomen demonstrated a cystic degenerated renal carcinoma, which had been cytologically tested also. The clinical course showed a typical aspect of a paraneoplastic syndrome: after extended nephrectomy a distinct regression of the musculary symptoms developed, but with the development of metastases the symptoms increased again. The interdependence of polymyositis and primary renal carcinoma would appear to be proven.