Vasculitis and Breast Cancer: Mind the Hint

Angiography Revealing a Possible Paraneoplastic Vasculitis: A Case Report

Various conditions under the umbrella term of vasculitis have been well documented in the literature. These have been classified into small, medium, and large vessel vasculitis. In addition, vasculitis has been categorized into radiation-induced, systemic, and paraneoplastic. Of these, paraneoplastic vasculitis accounts for 2-5% of all cases of vasculitides and is less well documented. We present a case of a female patient with a history of breast cancer presenting with an upper gastrointestinal tract (GI) bleed, which subsequently revealed an underlying diagnosis of systemic vasculitis, possibly paraneoplastic. This case highlights the importance of imaging for revealing underlying vasculitis as an etiology of GI bleed.

Case Report of MPO+ ANCA Vasculitis with Pauci-immune GN Associated with Invasive Ductal Carcinoma of the Breast

BACKGROUND

Malignancy-associated vasculitis usually presents in the form of polyarteritis nodosa or leukocytoclastic vasculitis. However, ANCA vasculitis associated with malignancy is rare. Here, we present a case of MPO+ ANCA vasculitis with pauci-immune GN associated with invasive ductal carcinoma of the breast.

CASE PRESENTATION

A 66-year-old female with a history of rheumatoid arthritis, Hashimoto's thyroiditis, and psoriasis presented with multiple joint pain, body aches, petechial rash, paresthesia and numbness, and deranged renal function a month after diagnosis of localized left breast invasive ductal carcinoma. Renal biopsy showed crescentic pauci-immune glomerulonephritis, and serology was positive for Perinuclear Antineutrophil Cytoplasmic Antibody (P-ANCA) and myeloperoxidase (MPO). The disease course was complicated by diverticulitis with peritonitis and intraperitoneal abscess collection, which required laparoscopic peritoneal lavage and additional interventional radiology-guided drainage of the abscess. We treated the patient successfully with steroids, rituximab, and mastectomy for left breast malignant lesions, resulting in the resolution of symptoms, normalization of inflammatory markers, and ANCA seroconversion.

CONCLUSION

Treating ANCA-associated Vasculitis (AAV) in surgical emergencies like bowel perforation can be challenging. Individualized treatment strategy tailored to patients' acute needs is crucial. In this case, we considered malignancy-associated vasculitis and pursued treatment that fit the patient's clinical situation in a multidisciplinary approach.

Cancer-associated vasculitides: a single-centre case series

OBJECTIVES

This study investigated the frequency of cancer-associated vasculitis, the types of associated cancers and vasculitides, and the temporal relationship in Korean patients who were diagnosed with both cancers and vasculitides.

METHODS

This study performed a digital search of the clinical data repository using selected diagnostic terms of vasculitides among patients diagnosed with cancers from May 2001 to May 2021. The time gap between the time of diagnosis of 'cancers' and that of 'vasculitides' was limited to 3 years. The types of cancers and vasculitides were reviewed.

RESULTS

The mean age of 73 patients with both cancers and vasculitides with a time gap of fewer than 3 years was 53.0 years and 42.5% were men. Of the 215,897 patients with cancers, 73 patients were also diagnosed with vasculitides (0.034%). The most common type of cancer was thyroid cancer (28.8%), followed by lymphoma (13.7%), whereas the most frequent type of vasculitis associated with cancer was Behcet disease (52.1%), followed by granulomatosis with polyangiitis (12.3%). The median time gap between cancer and vasculitis was - 17.0 days. Among vasculitides, Behcet disease was closely associated with various cancers compared to other types. Twenty-one patients exhibited both cancers and vasculitides between 0 and 90 days after the diagnosis of the corresponding cancer.

CONCLUSION

The frequency of cancer-associated vasculitis was 0.034% in Korean patients. The types of cancers and vasculitides in cancer-associated vasculitis and the distributions of sex and age may be dependent on ethnic and geographic differences. Key Points • The frequency of cancer-associated vasculitis was 0.034% in Korean patients. • The most common cancer and vasculitis in cancer-associated vasculitis were thyroid cancer and Behcet disease. • The types of cancers and vasculitides in cancer-associated vasculitis seemed to be dependent on ethnic and geographic differences.