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Abstract: PO1915

A Unique Case of Paraneoplastic Lupus Nephritis Biopsy Finding in a Patient with Head and Neck Cancer

Session Information

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Jain, Swati, Montefiore Health System, Bronx, New York, United States
  • Thakkar, Jyotsana, Montefiore Health System, Bronx, New York, United States
Introduction

Rheumatic disease can be one of manifestations of paraneoplastic syndrome. We present a case of supraglottic squamous cell carcinoma (SCC) associated nephrotic syndrome and kidney biopsy suggestive of lupus-like changes.

Case Description

56-year-old male with past medical history of hypertension, opioid abuse (on methadone) and an active smoker was admitted to the hospital for evaluation of painful neck swelling which he first noticed four days prior to admission. Examination was remarkable for lower extremity edema and left neck mass. Nephrology was consulted for evaluation of nephrotic syndrome. Significant laboratory workup revealed spot urine protein/creatinine ratio of 19 grams, serum albumin 2.2 g/dl and a normal serum creatinine 0.9 mg/dl. Serological workup for proteinuria including phospholipase A2 receptor antibody (PLA2R Ab) was negative. Biopsy of the neck mass was suggestive of supraglottic squamous cell carcinoma, subsequently treated with carboplatin and radiotherapy. A kidney biopsy was done for further evaluation. While there were no glomerular changes on light microscopy, immunofluorescence (IF) showed full house capillary staining (IgG, IgM, IgA, C3, C1q, kappa and lambda light chains). Also, enhanced glomerular staining for PLA2R was seen. Electron microscopy revealed sub epithelial deposits. Given lupus like finding on IF, serologies were tested and were negative. Given absence of systemic symptoms of lupus, negative serologies and negative PLA2R Ab, presumed diagnosis of membranous glomerulonephritis secondary from malignancy was made. He was treated conservatively with diuretics, angiotensin convertase inhibitor and anticoagulation for thromboembolism prevention. Proteinuria improved with above treatment, however patient expired due to tumor complications and metastasis.

Discussion

Paraneoplastic systemic lupus erythematous has been reported in patients with solid tumors. Proposed hypothesis is tumor driven breakdown of self-tolerance antigens, which causes generation of auto antibodies. Auto immune disease usually precedes the diagnosis of malignancy and patients develop symptoms later. Our case is unique, although biopsy was indicative of lupus nephritis, patient had no clinical or laboratory finding for lupus. Nephrologist and oncologist should be aware of this rare clinical association for appropriate diagnosis and management