Abstract
Autoimmune hemolytic anemia (AIHA) is a disease process that involves the destruction of red blood cells mediated by the humoral immune system. It can be characterized as a cold agglutinin syndrome, paroxysmal cold hemoglobinuria, and warm, mixed type, and drug-induced AIHA. Although a well-established relationship exists between the presence of AIHA and lymphoproliferative malignancy, AIHA rarely presents in association with solid malignancies. An analysis of the limited number of published cases of AIHA in association with solid malignancies performed showed that AIHA may present before the diagnosis of a solid malignancy, concurrently with the presence of a solid malignancy, or even on resolution of a solid malignancy. Few cases of solid cancers associated with AIHA have been reported. AIHA rarely presents as a paraneoplastic syndrome indicating existence of a solid cancer. We report a case of inflammatory breast cancer with AIHA.
Highlights
The association between autoimmune hemolytic anemia (AIHA) and lymphoproliferative disorders is well-established.[1,2,3] significantly fewer cases of AIHA have been reported in malignant solid cancers,[4] with a notably rare occurrence in breast malignancy
In a 2016 Bulgarian study that focused on assessing the incidence of autoimmune disorders and solid tumors, out of the 1083 patients with solid tumors that were studied, only 1.29% of the solid tumors were associated with autoimmune paraneoplastic syndromes
Of the solid tumors that had autoimmune paraneoplastic syndromes, 14% were associated with AIHA, and these were related to either a solid tumor of the prostate or of the ovary with none associated with a solid breast malignancy
Summary
The association between autoimmune hemolytic anemia (AIHA) and lymphoproliferative disorders is well-established.[1,2,3] significantly fewer cases of AIHA have been reported in malignant solid cancers,[4] with a notably rare occurrence in breast malignancy. Additional workup revealed a haptoglobin level 19%, and an immunoglobulin G (IgG) positive direct Coombs test, suggesting AIHA Based on these findings, the patient received multiple transfusions of packed red blood cells in addition to methylprednisolone for her hemolytic anemia. Treatment of the AIHA depends on the characteristics of the concurrent solid tumor For this patient’s breast cancer, which was estrogen receptor positive, progesterone receptor negative, and positive for HER2 gene expression, docetaxel, transtuzumab, and pertuzumab were initiated. Recurrence of the AIHA following 6 cycles of chemotherapy in a patient with progression of metastatic breast cancer suggests that the recurrent AIHA may be secondary to the progression of the metastatic breast cancer that has become unresponsive to the chemotherapy
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