Abstract
BackgroundLeser–Trélat syndrome, which manifests as eruptive multiple seborrheic keratoses, is a rare paraneoplastic sign. Hyponatremia in the elderly population is an often overlooked but potentially sinister biochemical abnormality. Cancer-related causes of hyponatremia include syndrome of inappropriate antidiuretic hormone secretion, cerebral or renal salt wasting, and adrenal dysfunction. We report a case of an elderly man who presented with both syndrome of inappropriate antidiuretic hormone secretion and Leser–Trélat syndrome, and was eventually found to have renal malignancy.Case presentationA 74-year-old indigenous Malaysian man with underlying chronic kidney disease presented with recurrent admissions for hyponatremia with parameters indicative of syndrome of inappropriate antidiuretic hormone secretion, constitutional symptoms, and diffuse skin lesions suggestive of multiple seborrheic keratoses. A radiological workup revealed metastatic renal cell carcinoma with evidence of metastasis to the brain, adrenal glands, bone, and lungs.ConclusionsTo the best of our knowledge, renal malignancy presenting as syndrome of inappropriate antidiuretic hormone secretion and Leser–Trélat concurrently is rare. The causes of hyponatremia in the elderly, approach to investigation, and value as a poor prognostic marker in malignancy are highlighted. We also discuss Leser–Trélat syndrome, its pathophysiology, and its possible implications on clinical practice.
Highlights
ConclusionsTo the best of our knowledge, renal malignancy presenting as syndrome of inappropriate antidiuretic hormone secretion and Leser–Trélat concurrently is rare
Leser–Trélat syndrome, which manifests as eruptive multiple seborrheic keratoses, is a rare paraneoplastic sign
We report a case of a 74-year-old man who presented with recurrent admissions for hyponatremia, complaining of constitutional symptoms and diffuse skin lesions suggestive of multiple seborrheic keratoses
Summary
To the best of our knowledge, renal malignancy presenting as SIADH and Leser–Trélat concurrently is rare. There are a few clinical lessons from this case. Elderly patients presenting with hyponatremia should always warrant purposeful investigations to elicit the cause. Recurrent hyponatremia in the presence of constitutional symptoms should raise clinical alarms of malignancy especially if refractory to hydration and orally administered sodium supplementation. The dermatological sign of Leser–Trélat or Leser–Trélat syndrome may be a warning sign of occult malignancy, and it remains to be further proven with concrete evidence, it is useful as a clinical bedside tool
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