The online version of this article (doi:10.1186/1752-1947-6-261) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
SF collected retrospective data from medical records and performed a literature review for the condition. LN analyzed the histological samples and identified illustration samples for the manuscript. SW and TJ reviewed the manuscript and cleaned up the data. All authors reviewed and approved the final manuscript.
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.
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.
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.
Greer JM, Longley S, Edwards NL, Elfenbein GJ, Panush RS: Vasculitis associated with malignancy. Experience with 13 patients and literature review. Medicine (Baltimore). 1988, 67: 220-230. CrossRef
Hayem G, Gomez M, Grossin M, Meyer O, Kahn M: Systemic vasculitis and epithelioma: a report of three cases with a literature review. Rev Rhum Eng Ed. 1997, 64: 816-824.
Fain O, Hamidou M, Cacoub P, Godeau B, Wechsler B, Pariès J, Stirnemann J, Morin AS, Gatfosse M, Hanslik T, Belmatoug N, Blétry O, Cevallos R, Delevaux I, Fisher E, Hayem G, Kaplan G, Le Hello C, Mouthon L, Larroche C, Lemaire V, Piette AM, Piette JC, Ponge T, Puechal X, Rossert J, Sarrot-Reynauld F, Sicard D, Ziza JM, Kahn MF: Vasculitides associated with malignancies: analysis of sixty patients. Arthritis Rheum. 2007, 57: 1473-1480. 10.1002/art.23085. CrossRefPubMed
- Paraneoplastic leukocytoclastic vasculitis as an initial presentation of malignant pleural mesothelioma: a case report
Shu Fen Wong
Shane C White
- BioMed Central