A Case of Lung Cancer in an 83-year-old Male Patient with Systemic Lupus Erythematosus-like Symptoms as Paraneoplastic Syndrome

Abstract

An 83-year-old man was found having a nodule in the left lower lobe of the lung during the examination of appetite loss. Computed tomography (CT)-guided lung biopsy revealed non-small cell carcinoma, and the clinical stage was IIIB from PET-CT findings. Pre-treatment examination showed leukocytopenia (the WBC count of 1,200/μL) and coagulation disorder (the PT-INR of 5.16 and the APTT of 107 seconds). He was diagnosed with systemic lupus erythematosus (SLE) with increases of antinuclear antibody to 5,120 times and anti-DNA antibody to 9.9 IU/ml. No clinical symptoms of SLE such as butterfly rush, arthralgia, renal impairment were observed. Coagulation disorder was relieved with Vitamin K, but leukocytopenia was not improved despite steroid treatment. A chest CT scan one month after the treatment revealed a growth of the lung tumor and reduction of mediastinal lymph nodes, therefore we performed partial resection of left lower lobe of the lung. The pathological diagnosis was combined large cell neuroendocrine carcinoma. After the resection of the tumor, leukocytopenia was improved, and we stopped steroid medication. Neither lung cancer nor systemic lupus erythematosus recurred, but four months after the surgery he was found at home with the state of cardiopulmonary arrest. This case may suggest that SLE can be a paraneoplastic syndrome of lung cancer.