Paraneoplastic systemic lupus erythematosus associated with colorectal cancer

Oxford Medical Case Reports
Matthew J ReesFrancesco L Ierino

Abstract

A 64-year-old gentleman initially presented with nephrotic syndrome and membranous nephropathy with positive staining for C1q, which was suspicious for lupus membranous nephritis. Investigation led to the simultaneous diagnosis of colorectal cancer (CRC). The CRC was surgically excised and the patient's nephrotic syndrome resolved. The patient subsequently presented with classic systemic lupus erythematosus (SLE) including positive serological markers, mouth-ulcers and a photosensitive maculopapular rash. Two months later the patient represented with an SLE flare encompassing the full-hand of renal-pulmonary syndrome and vasculitic-neuropathy, importantly at this presentation occult recurrence of CRC was proven with tissue biopsy. Major histocompatibility class II haplotyping demonstrated HLA-DRB1*03, a known predisposition for SLE. This case depicts the scenario of tumour transformation triggering SLE development in a predisposed individual after an initial paraneoplastic manifestation in the form of membranous nephropathy (plus C1q). This supports the potential role of tumourgenesis in the development of SLE in a primed individual.

References

Apr 1, 1985·American Journal of Clinical Pathology·J C Jennette, C G Hipp
Sep 1, 1983·Kidney International·J C JennetteF G Dalldorf
Feb 8, 2006·Current Opinion in Rheumatology·Sasha BernatskyAnn Clarke
Nov 18, 2006·Autoimmunity Reviews·Eva SzekaneczZoltán Szekanecz
May 20, 2008·Autoimmunity Reviews·Vito RacanelliFederico Perosa
Mar 13, 2009·Journal of the American Society of Nephrology : JASN·Laurence H Beck, David J Salant
Sep 12, 2013·British Journal of Hospital Medicine·Daniele SolaMario Pirisi
Dec 30, 2014·International Journal of Rheumatic Diseases·Zhili NiuYongqing Tong

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Methods Mentioned

BETA
biopsy
surgical resection
PCR

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