Paraneoplastic leukocytoclastic vasculitis as an initial presentation of malignant pleural mesothelioma: a case report

Our plain-English summary of Paraneoplastic leukocytoclastic vasculitis as an initial presentation of malignant pleural mesothelioma: a case report, by S.F. Wong, L. Newland, T. John, et al (Journal of Medical Case Reports, 2012).

The study

• Authors: S.F. Wong, L. Newland, T. John, S.C. White
• Journal: Journal of Medical Case Reports
• Published: 2012;6:261
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Vasculitis has been associated with malignancies, more commonly hematological rather than solid malignancies. Due to the rarity of these conditions and the lack of a temporal association, the relationship between vasculitis and malignancy remains unclear. Paraneoplastic vasculitis as a phenomenon of lung cancer has been described in the literature. To the best of our knowledge, this is the first case report of leukocytoclastic vasculitis being an initial presentation of malignant pleural mesothelioma.

Case Presentation: We report the case of an 84-year old Greek man who presented to our facility with an erythematous, pruritic and purpuric rash affecting his limbs. This was biopsy-proven to be leukocytoclastic vasculitis and treated conservatively with topical corticosteroids as well as oral prednisolone, with good results. Six months later, he was diagnosed as having malignant pleural mesothelioma. As he remained asymptomatic from his malignancy, no systemic chemotherapy was instituted. He had a recurrence of biopsy-proven leukocytoclastic vasculitis two months after he was diagnosed as having mesothelioma, which again settled with conservative measures.

Conclusions: It is important to remain vigilant with regard to the association between leukocytoclastic vasculitis and malignancies. A diagnosis of vasculitis requires a search for malignancies as well as other possible etiologies. This is particularly of relevance when the vasculitis becomes chronic, recurrent or treatment is no longer effective. Should our patient have experienced refractory vasculitis, we would have instituted systemic chemotherapy to treat the underlying malignancy.

In plain English

This was a case report from Austin Health in Heidelberg, Victoria, Australia, about one 84-year-old Greek man. He had a one-month history of an itchy, scaly red rash that spread from his left ankle to his lower legs and hands. The article states he had no history of smoking, asbestos exposure or recent infections. A skin biopsy confirmed leukocytoclastic vasculitis (LCV), an inflammation of small blood vessels. The rash cleared with oral prednisolone and steroid creams. Six months later he developed fluid around the right lung. A biopsy confirmed biphasic malignant pleural mesothelioma involving the parietal pleura. Because he had no other symptoms, he declined chemotherapy. Two months after the mesothelioma diagnosis the vasculitis returned, was again confirmed by biopsy, and again responded to steroids. Eight months after diagnosis he was reported to be well with no evidence of progression. The authors believed this to be the first reported case of LCV presenting with pleural mesothelioma. They concluded that vasculitis that does not respond to usual treatment should prompt a search for an underlying cancer.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One previously well 84-year-old Greek man treated at Austin Health, Heidelberg, Victoria, Australia (the authors' institution). The dates of care are not given.
• Exposure: The article reports no history of asbestos exposure (and no smoking or recent infections) for this patient. No fiber type or job is described.
• Main results:
  • The skin rash was biopsy-confirmed leukocytoclastic vasculitis and resolved with oral prednisolone and topical corticosteroids.
  • Six months later, after a right-sided pleural effusion, a thoracoscopic biopsy confirmed biphasic malignant pleural mesothelioma of the parietal pleura.
  • At the time of the mesothelioma, his C-reactive protein was raised at 293.3 mg/L (normal below 8 mg/L).
  • Because he had no other symptoms, the patient declined systemic chemotherapy.
  • The vasculitis recurred two months after the mesothelioma diagnosis, was confirmed by biopsy, and again responded to steroids.
  • Eight months after diagnosis, the patient was reported well without evidence of progression.
• The authors' conclusion: The authors concluded that, to their knowledge, this was the first reported case of LCV presenting with malignant pleural mesothelioma. In their view, vasculitis may come before the mesothelioma diagnosis by months, and failure of LCV to respond to usual treatment should prompt a search for an underlying cancer.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Lung Cancer, Biopsy, Chemotherapy, Mesothelioma.

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• Pleural mesothelioma with initial presentation as cervical lymphadenopathy — E.J. Wills (1995)
• Systemic lymphadenopathy as the initial presentation of malignant mesothelioma: a report of three cases — Y. Zhang, Z.M. Taheri, et al. (2010)
• Phrenic nerve paralysis as the initial presentation in pleural sarcomatoid mesothelioma — G. Makimoto, K. Fujiwara, et al. (2014)
• Breast metastasis as the initial presentation of malignant pleural mesothelioma — L. Korša, A. Lukač, et al. (2020)

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