ACQUIRED ICHTHYOSIS: A RARE PRESENTATION OF LUNG CANCER

Abstract

SESSION TITLE: Lung Cancer 2 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Acquired ichthyosis (AI) is a skin condition characterized by dry, rough and scaling skin, often described as “fish scale skin”. AI can be either congenital or acquired and can be associated with malignancies, lupus, chronic liver disease, kidney disease, malnutrition, AIDS and certain medications. Cancers associated with AI include but are not limited to: Hodgkin's lymphoma, lung and breast adenocarcinoma. Although AI is associated with underlying malignancy, this skin finding is not always recognized and is often treated independently and thus, a diagnostic evaluation for an underlying malignancy is not always performed. CASE PRESENTATION: A 54-year-old Caucasian male, who is an 80 pack year smoker and type 2 diabetic, presented to the ER with dizziness and syncope. He reported shoulder pain from falling, anorexia and unintentional weight loss. He had no shortness of breath, cough, hemoptysis, night sweats or fatigue. On exam, he was cachectic with severe dry, rough scaling skin especially to the palms and plantar surfaces (Figure1&2). He reported that this skin finding had been present for 2 months. CT of the head showed: a right frontal mass and a second heterogeneous mass within the cerebellum. So, a chest x-ray was obtained to evaluate for a possible primary neoplasm and showed a left peri-hilar mass. CT chest was subsequently completed and showed a left lower lobe mass with mediastinal lymphadenopathy, which CT guided biopsy later confirmed as small cell undifferentiated carcinoma. Podiatry was consulted for his skin findings which were believed to be paraneoplastic acquired ichthyosis and keratolytic therapy with 40% urea cream was ordered. Oncology was consulted and palliative radiation for brain metastasis and chemotherapy were started. Unfortunately, the patient died 4 months after his diagnosis was made. DISCUSSION: Lung cancer is associated with multiple paraneoplastic phenomena, including AI. Early recognition of cancer is very important especially in fast growing small cell lung cancers. As shown in this case, AI presented 2 months before the diagnosis of cancer was confirmed. This diagnosis could have been made earlier if a thorough evaluation by a dermatologist or a podiatrist was obtained. Furthermore review of the current literature and case reports on AI are very limited. Therefore, a high index of suspicion in the appropriate clinical scenario is warranted and can make a difference in the early diagnosis and treatment of associated malignancy. Unfortunately, for our patient his diagnosis of AI was made simultaneously with his diagnosis of metastatic lung cancer and so he lost an opportunity for earlier diagnosis. CONCLUSIONS: Paraneoplastic syndromes might be the first red flag observed with the presentation of cancer. Therefore, it is crucial that rare manifestation such as AI be recognized and investigated to rule underlying malignancy. Reference #1: Okulicz JF, Schwartz RA. Hereditary and acquired ichthyosis vulgaris. Int J Dermatol 2003; 42:95–8. Reference #2: Penven K, Verneuil L, Dompmartin A, Louvet S, Leroy D. An association of paraneoplastic syndromes in a patient. Ann Dermatol Venereol. 2002; 129(8-9):1042-5. Reference #3: Patel N, Spencer LA, English JC, Zirwas MJ. Acquired ichthyosis. J Am Acad Dermatol 2006; 55:647. DISCLOSURES: No relevant relationships by Haytham Adada, source=Web Response No relevant relationships by Mahmoud Amarna, source=Web Response No relevant relationships by Camelia Chirculescu, source=Web Response No relevant relationships by AHMAD HAMMAD, source=Web Response No relevant relationships by Leisa Walker, source=Web Response