1347 From the Outside Looking in: Psoriasiform Dermatitis Presenting as a Paraneoplastic Syndrome for Pancreatic Adenocarcinoma

Abstract

INTRODUCTION: Cancer is a devastating finding but diagnosis can be difficult due to the vague symptoms and often indolent course. Sometimes, medical professionals have clues to possible malignancy precursors but it can easily be overlooked when they are presented in different clinical pictures. Paraneoplastic syndromes range from almost ever organ system but the case discussed here deals with a rare cutaneous manifestation that can be seen with a number of malignancies known as bazex syndrome. CASE DESCRIPTION/METHODS: This case involved a 64-year-old female with history of hypertension and paroxysmal atrial fibrillation who came to the hospital with complaints of yellow discoloration of her skin, intermittent fevers and a recent history of right upper quadrant pain with nausea. She was seen by her primary care physician who did basic labs that showed a total bilirubin of 14.3 and she was sent to the emergency room for further evaluation. Of note, patient was previously seen in the hospital 6 months prior for a skin rash on her extremities and abdomen that was biopsied and later described as psoriasiform dermatitis. It was thought to be a drug reaction from a medication but the rash still persisted after discontinuation. On this admission, a CT abdomen showed masses in the pancreatic head and neck with confluent disease encasing the periportal structures that was concerning for malignancy. Biopsy after endoscopic ultrasound showed adenocarcinoma and the patient was evaluated by oncology with gastroenterology and she had biliary sphincterotomy with stenting and was started on modified FOLFIRINOX therapy. DISCUSSION: This case highlights a rare finding with the psoriasiform dermatitis rash that erupted a few months prior to formal diagnosis of pancreatic adenocarcinoma, which is concerning for an uncommon paraneoplastic process known as bazex syndrome. What makes this case even more uncommon is that bazex is usually seen in head, neck and lung cancers and is less commonly seen in gastrointestinal malignancies. Clinicians should be made aware of these cutaneous changes, so that they can improve on early evaluation, diagnosis and possible treatment.