Paraneoplastic syndrome affects less than 1% of cancer patients. Diagnosis of paraneoplastic syndrome with neurological presentation requires screening for an underlying malignancy, including a complete history, physical examination and imaging studies. Treatment often results in symptom stability, rather than improvement. Paraneoplastic polymyositis can precede or instantaneously occur at diagnosis or treatment of a primary tumour, while neurological symptoms can persist even following cancer treatment. We report a rare case of metaplastic breast carcinoma with an unusual presentation of paraneoplastic polymyositis. KEYWORDSParaneoplastic syndrome -Metaplastic carcinoma -Diagnosis -Neurology -Breast cancer Paraneoplastic syndrome is a rare condition, affecting less than 1% of cancer patients.1 Diagnosis of paraneoplastic syndrome with neurological presentation requires screening for an underlying malignancy. This process includes a complete history, physical examination and imaging studies. 1Treatment often results in symptom stability, rather than improvement.1 Paraneoplastic polymyositis can precede or instantaneously occur at diagnosis or treatment of a primary tumour. Neurological symptoms can persist even following cancer treatment.2 Polymyositis belongs to a heterogeneous group of autoimmune diseases called inflammatory myopathies, which are characterised by proximal skeletal muscle weakness, cutaneous manifestations, elevated serum creatine kinase activity and inflammatory cells in muscle biopsy. Polymyositis is a cell-mediated autoimmune disorder. 3 The first reported association between malignancy and myositis was made by Stertz G et al in 1916. 4 The reported incidence for inflammatory myositis varies from 0.5 to 0.89 per 100,000 per year. 5We report a rare case of metaplastic breast carcinoma with an unusual presentation of paraneoplastic polymyositis. Case presentationA 66-year-old caucasian female presented with progressive difficulties with walking and climbing stairs, and developed proximal muscle weakness, paresthesia and gait ataxia over a period of 11 months. She became wheelchair-dependent and required hospital admission under the care of a neurologist. The patient had no relevant past medical history.Cerebrospinal fluid oligoclonal bands were negative, and a raised creatine kinase (CPK) level of 825 IU/L was detected on admission. Autoantibodies directed against antiRo, anti-Jo and anti-La, and extractable nuclear antigen antibodies, were detected. The antinuclear antibody test was positive. Electromyography was consistent with myopathy. An open-muscle biopsy of the leg revealed endomysial mononuclear cells and myonecrosis indicative of inflammatory myopathy.Patient was referred for radiological investigations. Computed tomography of the chest, abdomen and pelvis was unremarkable. Magnetic resonance imaging of the lower limbs showed inflammatory changes consistent with myositis and myopathy. As part of the investigations for the neurological presentation of paraneoplastic syndrome wi...
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