Negrão Catarina, Machado Marta, Mourato Margarida, Sismeiro Rita, Jonet Marta
Internal Medicine, Hospital Professor Doutor Fernando Fonseca, Amadora, PRT.
Cureus. 2023 Feb 28;15(2):e35566. doi: 10.7759/cureus.35566. eCollection 2023 Feb.
Paraneoplastic pruritus has been reported mostly in association with haematological malignancies, and rarely with solid tumours. Aquagenic pruritus is itching without any skin lesion that develops a few minutes after contact with water of any temperature and it is associated with polycythaemia vera or other lymphoproliferative diseases. Here we report a case of a previously healthy 78-year-old Portuguese woman, who had been treated unsuccessfully for aquagenic pruritus for the previous eight months, and presented to the emergency department complaining of pain and swelling in her left leg. Deep vein thrombosis was diagnosed and oral anticoagulation was initiated. Blood tests revealed a normal blood count and normal liver enzymes, except for alkaline phosphatase and lactate dehydrogenase levels, which were slightly elevated. Hypercobalaminaemia and folic acid deficiency were also noted. JAK2 V617F/12 exon mutation was not present. Thoracic, abdominal and pelvic computed tomography revealed a locally advanced pancreatic tumour. Ultrasound-guided fine-needle aspiration cytology of the lesion revealed a moderately differentiated adenocarcinoma of pancreatic ductal origin. Tumour marker assays showed elevation of both carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9). Aquagenic pruritus should be thoroughly investigated to exclude a neoplastic disease, especially if treatment is refractory or if another paraneoplastic syndrome is present. Although aquagenic pruritus is more commonly associated with haematological malignancies than solid tumours, a rare case of aquagenic pruritus is described here as a paraneoplastic syndrome of pancreatic cancer. To the best of our knowledge, this is the first case of pancreatic cancer that presented with aquagenic pruritus and dual paraneoplastic syndromes.
副肿瘤性瘙痒大多报道与血液系统恶性肿瘤相关，与实体肿瘤相关的情况很少见。水源性瘙痒是指在接触任何温度的水后几分钟内出现的无任何皮肤损害的瘙痒，它与真性红细胞增多症或其他淋巴增殖性疾病有关。在此，我们报告一例既往健康的78岁葡萄牙女性病例，她在过去八个月里因水源性瘙痒接受治疗但未成功，现因左腿疼痛和肿胀到急诊科就诊。诊断为深静脉血栓形成并开始口服抗凝治疗。血液检查显示除碱性磷酸酶和乳酸脱氢酶水平略有升高外，血常规和肝酶均正常。还发现了高钴胺血症和叶酸缺乏。未检测到JAK2 V617F/12外显子突变。胸部、腹部和盆腔计算机断层扫描显示局部晚期胰腺肿瘤。病变的超声引导下细针穿刺细胞学检查显示为中等分化的胰腺导管起源腺癌。肿瘤标志物检测显示癌胚抗原（CEA）和糖类抗原19-9（CA 19-9）均升高。对于水源性瘙痒应进行全面检查以排除肿瘤性疾病，特别是在治疗无效或存在其他副肿瘤综合征的情况下。虽然水源性瘙痒与血液系统恶性肿瘤的相关性比实体肿瘤更常见，但本文描述了一例罕见的水源性瘙痒作为胰腺癌的副肿瘤综合征病例。据我们所知，这是首例出现水源性瘙痒和双重副肿瘤综合征的胰腺癌病例。
