Washco Vaughan, McCarron Ross, Engel Lee S, Kamboj Sanjay, Lopez Fred A
A third-year Internal Medicine Resident at the Louisiana State University Health Sciences Center in New Orleans.
Assistant Professor of Clinical Medicine at LSUHSC-New Orleans.
J La State Med Soc. 2014 Nov-Dec;166(6):268-71. Epub 2014 Dec 15.
A 63-year-old woman with a history of infiltrating ductal breast cancer, status post-mastectomy and chemotherapy, was in remission for 18 months prior to being admitted to the hospital with complaints of a pruritic erythematous macular rash involving her head, chest, and bilateral upper and lower extremities. Along with the dermatologic manifestations, physical exam revealed proximal symmetrical muscle weakness and bilateral axillary lymphadenopathy. Initial workup for muscle weakness revealed a creatine kinase of 2,200 IU/L (normal 20-180 IU/L). After administration of intravenous fluids for renal protection, serum sodium dropped to 121 mEQ/L (normal 135-145 mEQ/L). Computed tomography of the chest showed axillary and supraclavicular lymphadenopathy. Biopsy of a supraclavicular node revealed infiltrating ductal cancer with histologic and morphologic characteristics similar to her previous breast cancer. Following an extensive laboratory workup, we concluded that our patient's myositis and hyponatremia were paraneoplastic syndromes secondary to her recurrent breast cancer.
一名63岁女性，有浸润性导管乳腺癌病史，接受过乳房切除术和化疗，在因头部、胸部及双侧上下肢出现瘙痒性红斑丘疹而入院前已缓解18个月。除了皮肤表现外，体格检查发现近端对称性肌无力和双侧腋窝淋巴结病。肌无力的初步检查显示肌酸激酶为2200 IU/L（正常范围20 - 180 IU/L）。在给予静脉输液以保护肾脏后，血清钠降至121 mEQ/L（正常范围135 - 145 mEQ/L）。胸部计算机断层扫描显示腋窝和锁骨上淋巴结病。锁骨上淋巴结活检显示为浸润性导管癌，其组织学和形态学特征与她之前的乳腺癌相似。经过广泛的实验室检查，我们得出结论，患者的肌炎和低钠血症是其复发性乳腺癌继发的副肿瘤综合征。
