Phillips Emma Catherine, Clark Meagan J, Schirtzinger Matthew
Internal Medicine, Ohio State University Foundation, Columbus, Ohio, USA
Ohio State University Foundation, Columbus, Ohio, USA.
BMJ Case Rep. 2025 Feb 13;18(2):e261681. doi: 10.1136/bcr-2024-261681.
A woman in her 70s with a past history of breast cancer in remission presented with several months of dyspnoea, skin tightness and Raynaud's phenomenon. Physical examination was significant for hypertension, hypoxaemia, sclerodactyly, diffuse crackles on auscultation and mild respiratory distress. Work-up revealed elevated serum creatinine, elevated right ventricular systolic pressure on echocardiography and nuclear bone scan findings of osseous metastatic disease. Captopril was initiated with concern for scleroderma renal crisis. The scleroderma panel was positive for RNA polymerase 11 and 155. Vertebral biopsy was diagnostic of recurrent breast cancer. Through multidisciplinary discussion, rituximab was initiated, and malignancy treatment was deferred; however, the patient developed several complications and ultimately elected to pursue inpatient hospice. In the setting of recurrent breast cancer, this case is suggestive of paraneoplastic scleroderma. The presence of underlying malignancy is an important consideration in new cases of scleroderma, and multidisciplinary management is key to determining treatment preference.
一位70多岁的女性，既往有乳腺癌病史且处于缓解期，出现了数月的呼吸困难、皮肤紧绷和雷诺现象。体格检查发现有高血压、低氧血症、指端硬化、听诊时有弥漫性湿啰音以及轻度呼吸窘迫。检查发现血清肌酐升高、超声心动图显示右心室收缩压升高以及核素骨扫描发现骨转移疾病。考虑到硬皮病肾危象，开始使用卡托普利治疗。硬皮病相关检查显示RNA聚合酶11和155呈阳性。椎体活检诊断为复发性乳腺癌。经过多学科讨论，开始使用利妥昔单抗治疗，恶性肿瘤治疗被推迟；然而，患者出现了多种并发症，最终选择住院接受临终关怀。在复发性乳腺癌的情况下，该病例提示副肿瘤性硬皮病。在硬皮病新病例中，潜在恶性肿瘤的存在是一个重要的考虑因素，多学科管理是确定治疗方案的关键。
