Testicular cancer as an underlying cause of intractable chronic pruritus.

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Conflict of interest: the authors declare that they have no conflicts of interest. Generalized pruritus without obvious cause should prompt a search for an underlying neoplastic disorder, especially haematological malignancy and certain carcinomas. Investigations included blood tests, radiography and scans, but a detailed history and examination are essential.1 We present a previously unreported malignant cause of pruritus, and stress the need for complete clinical assessment. A 59‐year‐old man presented in February 2010 with a 2‐year history of pruritus, worsening over the previous year and most intense on his back. The itch disrupted his sleep and was often intolerable during his waking hours. The itch was accompanied by skin discomfort after a bath or after prolonged standing. Antihistamine therapies, topical steroids and emollients had not relieved and had possibly even intensified the itch. He reported no other symptoms and had no previous skin problems. On physical examination, faint erythema was seen on the patient's back with excoriations over his arms, thighs and back. Investigations included haematological, biochemical and immunological blood tests and radiology, but the only abnormal finding was a slightly raised IgG and IgM. There was no improvement over 6 months.