Small cell lung carcinoma with three paraneoplastic syndromes in one patient

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: This is a case of patient who was diagnosed with Small Cell Lung Carcinoma(SCLC)after presenting with symptoms of Dermatomyositis(DM), SIADH and Lambert–Eaton myasthenic(LEMS)syndrome CASE PRESENTATION: Patient initially presented to the clinic with erythematous patches scattered on the trunk, extremities, and scalp associated with pain, itchiness and hair loss for two months. Biopsy from rash showed perifollicular and mild superficial perivascular inflammation. The patient was treated for viral exanthem with steroids. Patient subsequently presented to the hospital with worsening pruritic patches on scalp and entire body and periorbital edema. This was associated with weakness and generalized malaise. The weakness and pain were worse with neck and shoulder movements and the weakness improved on exertion. Other symptoms were productive cough, rhinorrhea, nasal congestion and sore throat for a month associated with 20 pounds weight loss. Physical exam showed decreased breath sounds in the left upper and middle field.No lower extremity swelling.Skin findings were violaceous edematous periorbital erythema(heliotrope rash), erythema of neck, upper chest, and entire back, erythematous slightly scaly plaques overlying MCPs and PIPs(Gottron\u27s papules). Labs showed CPK of 868, Aldolase of 8.9, serum sodium of 115(Serum osmolality 248, Urine osmolality 497, TSH 1.7, random cortisol 20.7)and ANA(1:320)was positive. Chest x-ray showed left upper lobe mass. CT chest showed malignant process arising from the left upper lobe and to the mediastinum. She underwent bronchoscopy with FNA and endobronchial biopsy which showed SCLC. DISCUSSION: Paraneoplastic syndromes occur in approximately 10% of patients with lung cancer(1). SIADH occurs in 15% of SCLC patients. LEMS is present in approximately 1% to 3% of patients with SCLC. Off all cases of DM only 5.9% have lung cancer. In some cases these syndromes can be presenting sign of cancer. The early recognition of paraneoplastic syndromes may contribute to the detection of a highly treatable, early-stage tumor. At other times, the syndromes may occur late in the course of disease or may appear as the first sign of recurrence DM is associated with poor prognosis and improved SCLC tumor survival are seen in patients with LEMS(2). Management of hyponatremia is very important as it is associated with a poor prognosis regardless of an extensive or limited stage. SCLC patients with serum sodium less than 129 mmol/l had a median survival of 8.63 months compared to 13.6 months in patients with normal sodium, and the degree of hyponatremia is a significant predictor for prognosis(3). CONCLUSIONS: SCLC is associated with large number of paraneoplastic syndromes which can also be the initial presentation in some cases. Ability to identify these syndromes especially in high risk population can lead to early diagnosis and might carry a better prognosis in some patients