Skip to main content

Advertisement

Log in

Paraneoplastic Raynaud’s phenomenon in a breast cancer survivor

  • Case Report
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

A 35-year-old woman with a history of breast cancer, treated 3 years ago with surgery, radiation, and chemotherapy presented with a rapid onset of severe Raynaud’s phenomenon. On physical examination, she had digital ulcers and splinter hemorrhages; there were no signs of an underlying rheumatic condition. Laboratory evaluation revealed anemia, the presence of antinuclear antibody and slight depression in her serum complement C3 level. The remainder of her serologic evaluation, including extractable nuclear antigens, anti-double-stranded DNA antibody, antiphospholipid antibodies, rheumatoid factor, anti-neutrophil cytoplasmic antibodies, cryoglobulins, and cold agglutins, were negative. Within weeks of her presentation, she developed acute renal failure and bilateral lower extremity edema. A computed tomography scan of her abdomen and pelvis showed bulky lymphadenopathy and hydronephrosis; a pelvic lymph node biopsy revealed metastatic breast cancer. She was initially managed with passive rewarming strategies, topical antibiotics, vasodilator and anti-platelet therapy, but had a negligible response. However, once she was started on chemotherapy for her recurrent malignancy, there was a significant improvement in her Raynaud’s symptoms and resolution of her digital ulcers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Silman A, Holligan S, Brennan P, Maddison P (1990) Prevalence of symptoms of Raynaud’s phenomenon in general practice. BMJ 301:590–592

    Article  CAS  PubMed  Google Scholar 

  2. Wigley FM (1993) Raynaud’s phenomenon. Curr Opin Rheumatol 5:773–784. doi:10.1097/00002281-199305060-00013

    Article  CAS  PubMed  Google Scholar 

  3. Planchon B, Pistorius MA, Beurrier P, De Faucal P (1994) Primary Raynaud’s phenomenon: age of onset and pathogenesis in a prospective study of 424 patients. Angiology 45:677–686. doi:10.1177/000331979404500802

    Article  CAS  PubMed  Google Scholar 

  4. Racanelli V, Prete M, Minoia C et al (2008) Rheumatic disorders as paraneoplastic syndromes. Autoimmun Rev 7:352–358. doi:10.1016/j.autrev.2008.02.001

    Article  PubMed  Google Scholar 

  5. Papasavvas G, Goodwill CJ (1989) Scleroderma and breast Carcinoma. Br J Rheumatol 4:366–367. doi:10.1093/rheumatology/28.4.366

    Article  Google Scholar 

  6. Forbes AM, Woodrow JC, Verbov JL, Graham RM (1989) Carcinoma of breast and scleroderma; four further cases and a literature review. Br J Rheumatol 28:65–69. doi:10.1093/rheumatology/28.1.65

    Article  CAS  PubMed  Google Scholar 

  7. De Angelis R, Silveri F, Bugatti L et al (2003) Raynaud’s phenomenon after combined chemotherapy. Chemotherapy 49:267–268. doi:10.1159/000072453

    Article  PubMed  Google Scholar 

  8. Wigley FM, Hummers LK (2003) Management of Raynaud’s phenomenon and digital ischemic lesions in scleroderma. Rheum Dis Clin North Am 29:293–313. doi:10.1016/S0889-857X(03)00019-X

    Article  PubMed  Google Scholar 

  9. Papamichael D, Amft N, Slevin ML et al (1998) 5-Fluorouracil-induced Raynaud’s phenomenon. Eur J Cancer 34:1983. doi:10.1016/S0959-8049(98)00184-1

    Article  CAS  PubMed  Google Scholar 

  10. Berger CC, Bokemeyer C, Schneider M, Kuczyk MA, Schmoll HJ (1995) Secondary Raynaud’s phenomenon and other late vascular complications following chemotherapy for testicular cancer. Eur J Cancer 31A(13–14):2229–2238. doi:10.1016/0959-8049(95)00460-2

    Article  CAS  PubMed  Google Scholar 

  11. Reiser M, Bruns C, Hartmann P, Salzberger B, Diehl V, Fatkenheuer G (1998) Raynaud’s phenomenon and acral necrosis after chemotherapy for AIDS-related Kaposi’s sarcoma. Eur J Clin Microbiol Infect Dis 17(1):58–60. doi:10.1007/BF01584368

    Article  CAS  PubMed  Google Scholar 

  12. Candelaria M, Hurtado-Monroy R, Vargas-Viveros P, Carrillo-Munnoz S, Duenas-Gonzalez A (2007) Tamoxifen-associated vasculitis in a breast cancer patient. World J Surg Oncol 5:9. doi:10.1186/1477-7819-5-9

    Article  PubMed  Google Scholar 

  13. Baptista MZ, Prieto VG, Chon S, Hortobagyi GN, Esteva FJ (2006) Tamoxifen-related vasculitis. J Clin Oncol 24(21):3504–3505. doi:10.1200/JCO.2005.05.3322

    Article  PubMed  Google Scholar 

  14. Betto P, Gennari E, Germi L, Bonoldi E, Scalco G, Tosti A (2008) Tamoxifen and purpuric vasculitis: a case report. J Eur Acad Dermatol Venereol 22(6):762–763. doi:10.1111/j.1468-3083.2007.02479.x

    Article  CAS  PubMed  Google Scholar 

  15. Toumbis-Ioannou E, Cohen PR (1994) Chemotherapy-induced raynaud’s phenomenon. Cleve Clin J Med 3:195–199

    Google Scholar 

  16. Szekanecz E, Andras C, Sandor Z, Antal-Szalmas P, Szanto J, Tamasi L et al (2006) Malignancies and soluble tumor antigens in rheumatic diseases. Autoimmun Rev 6:42–47. doi:10.1016/j.autrev.2006.03.007

    Article  PubMed  Google Scholar 

  17. Adamus G (2003) Autoantibody-induced apoptosis as a possible mechanism of autoimmune retinopathy. Autoimmun Rev 2:63–68. doi:10.1016/S1568-9972(02)00127-1

    Article  CAS  PubMed  Google Scholar 

  18. Saiki M, Sakai K, Saiki S, Kitagawa Y, Nakanishi M, Hirose G (2005) Induction of humoral responses specific for paraneoplastic cerebellar degeneration-associated antigen by whole recombinant yeast immunization. J Autoimmun 24:203–208. doi:10.1016/j.jaut.2005.01.008

    Article  CAS  PubMed  Google Scholar 

  19. Lorusso L, Hart KI, Ferrari D, Ngonga KG, Gasparetto C, Ricevuti G (2007) Autonomic paraneoplastic neurological syndromes. Autoimmun Rev 6:162–168. doi:10.1016/j.autrev.2006.10.003

    Article  CAS  PubMed  Google Scholar 

  20. Hansen SW, Olsen N (1989) Raynaud’s phenomenon in patients treated with cisplatin, vinblastine, and bleomycin for germ cell cancer: measurement of vasoconstrictor response to cold. J Clin Oncol 7(7):940–942

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Written consent for publication was obtained from the patient.

Conflict of interest statement

The authors have no competing interests.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shikha Mittoo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Allen, D., Robinson, D. & Mittoo, S. Paraneoplastic Raynaud’s phenomenon in a breast cancer survivor. Rheumatol Int 30, 789–792 (2010). https://doi.org/10.1007/s00296-009-0985-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-009-0985-5

Keywords

Navigation