1989 Volume 12 Issue 1 Pages 107-113
We experienced a case of carcinoembryonic antigen (CEA)-producing lung cancer associated with polyarteritis nodosa (PN). A 62-year-old man admitted to the Shimane Medical University Hospital because of cough, sputum and fatigability. He was diagnosed as having pulmonary fibrosis and squamous cell carcinoma in the right hilar region. Serum CEA was elevated to 200 ng/ml. He underwent subtotal pneumonectomy of right lung. He had noticed motor weakness of extremities since before the operation. Fever, diarrhea and pleural effusion continued after the operation, although antibiotics were administered. Skin ulcer then occurred on the lower legs and sensory disturbance of extremities appeared. Laboratory examinations revealed elevated erythrocyte sedimentation rate, hyper-gammaglobulinemia, and positive C reactive protein. Auto-antibodies, cryoglobulin and hepatitis B antigen were all negative. Serum complements such as CH50, C3 and C4 were decreased and circulating immune complexes were detected by C1q, precipitation method. Muscle biopsy revealed necrotizing vasculitis of PN type. Using peroxidase-antiperoxidase method, CEA present in the affected vessel walls as well as in the cancerous tissue of the lung was demonstrated. The deposition of IgG was also observed in the affected vessel walls, suggesting a role of the immune complexes in the development of PN in this case. Prednisolone and cyclophosphamide were administered with temporary effect but the patient died of metastic liver cancer two months later. This case provided possible evidence that cancer-associated antigens and their immune complexes could play crucial role in the pathogenesis of PN.
