Henoch Schönlein purpura associated with pulmonary adenocarcinoma.

INTRODUCTION: Henoch-Schönlein purpura is a common immunoglobulin A-mediated vasculitis syndrome in children. Henoch-Schönlein purpura can also affect adults and is probably related to malignancy. CASE PRESENTATION: We report the case of a 61-year-old Japanese man who presented for examination after an abnormal shadow was detected by chest radiography. He received a diagnosis of pulmonary adenocarcinoma, stage IV. Purpura on the legs, abdominal pain, diarrhea, hematuria and proteinuria developed at this time. Henoch-Schönlein purpura was diagnosed, base on the clinical symptoms and histological findings of biopsy specimens of the skin, which showed vasculitis with immunoglobulin A deposits. Our patient received chemotherapy with gemcitabine after successful steroid therapy for the Henoch-Schönlein purpura. CONCLUSION: Although hematological malignancies are well-known causes of vasculitides, cases of Henoch-Schönlein purpura associated with lung adenocarcinoma are rare. Our patient was treated with corticosteroid therapy, which cleared the purpura and cytotoxic chemotherapy for the non-small cell lung cancer. However, he died from heart failure due to cardiac tamponade.

[Chronic intestinal pseudo-obstruction as a paraneoplastic presentation of limited-stage small cell lung cancer].

A 53-year-old woman with chief complaints of vomiting and constipation was given a diagnosis of ileus and admitted to a local hospital. The origin of the ileus was unknown despite intensive examinations. However, her chest X-ray film and CT showed left hilar and mediastinal lymphadenopathy. Her pro-gastrin-releasing peptide (ProGRP) levels were elevated. After transfer to our hospital, the diagnosis of small cell lung cancer (SCLC) was confirmed by transbronchial aspiration cytology. Since no cause of ileus was found on laparotomy, her symptoms were considered to indicate chronic intestinal pseudo-obstruction (CIPO), a manifestation of paraneoplastic neurological syndrome. Serum anti-Hu antibody testing was positive. Chemoradiotherapy induced complete remission and her abdominal symptoms markedly improved. This is a very rare case of CIPO accompanied with SCLC, which improved after immediate anti-tumor therapy for lung cancer.