Department of Internal Medicine, Cantonal hospital Baden, Baden, Switzerland
Department of Internal Medicine, Cantonal hospital Baden, Baden, Switzerland.
BMJ Case Rep. 2024 Apr 29;17(4):e254824. doi: 10.1136/bcr-2023-254824.
A female patient in her 70s with a newly diagnosed clear cell renal cell carcinoma (ccRCC) with osseous metastasis presented with sudden onset erythematous painful blistering skin lesions on the dorsum of both hands, with associated intermittent fever episodes. Blood tests showed elevated inflammatory marker levels (C reactive protein 257.8 mg/dL, leucocytes 17.79×10⁹/L, with 94% neutrophils). Histologically, there was predominately neutrophil dermal infiltrate without leucocytoclastic vasculitis. The diagnostic criteria of Sweet syndrome were fulfilled. A week later, the patient developed abrupt left-hand palsy, which was confirmed as a medial and ulnar sensorimotor axonal peripheral neuropathy of paraneoplastic origin. The patient was prescribed a course of oral high-dose steroids, which significantly improved the skin lesions. The peripheral nerve palsy improved after 3 months. This case describes the two very rare concurrent paraneoplastic manifestations of ccRCC occurring simultaneously, which have been rarely reported.
一位 70 多岁的女性新诊断为透明细胞肾细胞癌（ccRCC）伴骨转移患者，双手背部突然出现红斑性疼痛性水疱样皮肤损伤，伴有间歇性发热。血液检查显示炎症标志物水平升高（C 反应蛋白 257.8mg/dL，白细胞 17.79×10⁹/L，中性粒细胞 94%）。组织学上，主要为中性粒细胞真皮浸润，无白细胞碎裂性血管炎。符合Sweet 综合征的诊断标准。一周后，患者出现突发性左手无力，经证实为副肿瘤性正中神经和尺神经感觉运动轴索性周围神经病。患者接受了口服大剂量类固醇治疗，皮肤损伤明显改善。3 个月后周围神经麻痹改善。本例描述了两种非常罕见的 ccRCC 同时发生的副肿瘤表现，这种情况很少有报道。
