Purpose Vasculitis has occasionally been reported in association with hematologic malignancies. We report a rare case of microscopic polyangitis in a patient with head and neck malignancy.
Case Report A 50 year old white male with a history of discoid lupus, hypertension, coronary artery disease, tobacco and alcohol abuse was diagnosed with squamous cell carcinoma of the head and neck in June 2004. He completed a full course of radiation therapy and two cycles of chemotherapy with cisplatin. Two months later, he was admitted for mucositis. His physical examination was significant for oral ulcerations and cervical lymphadenopathy. During his hospitalization, he developed a pulmonary-renal syndrome with respiratory and acute renal failure requiring intubation. A computerized tomographic scan of chest revealed multifocal airspace disease with diffuse ground glass opacities and bilateral pleural effusions. A video assisted thoracoscopic lung biopsy indicated cryptogenic organizing pneumonia (also known as bronchiolitis obliterans and organizing pneumonia). To evaluate his deteriorating renal function and glomerular hematuria, this patient underwent a renal biopsy indicating acute tubular necrosis and pauci immune crescentic glomerulonephritis. Laboratory tests included creatinine 4 mg/dL; normal liver function tests; positive antinuclear antibodies 1:160 and a positive perinuclear anti-neutrophil cytoplasmic antibodies (P-ANCA) 1:512 FIU. Cryoglobulins, hepatitis B surface antigen, hepatitis C virus antibody, anti-glomerular basement membrane, anti-double stranded DNA and anti-smith antibodies were absent. Bacterial, mycobacterial and fungal cultures were negative. The patient received intravenous Solu-Medrol and cyclophosphamide and his pulmonary status and renal function recovered sufficiently to return home.
Discussion and Conclusion Patients with neoplasia may present with variety of paraneoplastic manifestations including vasculitis, though most commonly leukocytoclastic vasculitis, which occurs temporal to the diagnosis of malignancy. Greer et al reported a statistically significant association between vasculitis and lymphomyeloproliferative malignancies. However, there have been few cases of vasculitis in association with solid tumors. We report a case of microscopic polyangitis developing in a patient within two months of diagnosis of head and neck malignancy. Further studies of this association may reveal a pathogenic link between malignancy and vasculitis.