PARANEOPLASTIC INTERSTITIAL GRANULOMATOUS DERMATITIS WITH ARTHRITIS AND PARANEOPLASTIC RHEUMATOID-ARTHRITIS REVEALING A LUNG-CANCER

Introduction. Interstitial granulomatous dermatitis is a histological entity usually associated with systemic auto-immune conditions or mali gnant lymphoproliferation. Its spontaneous regression after surgical t reatment of a lung cancer suggests an eventual paraneoplasic variant. Observation. A 62 pear old male patient, a smoker, was hospitalized fo r weakness, pruritus and symmetrical arthritis of small and large join ts. Numerous rheumatoid nodules were located on the extensor aspects o f the involved joints. During hospitalization, he developed an inflamm atory plaque located on a thigh, which showed histologic features cons istent with the diagnosis of interstitial granulomatous dermatitis. He had elevated E.S.R.. blood eosiniphilia, and the search for antinucle ar antibodies and antineutrophilic leukocyte cytoplasm antibodies (ANC A), of the p-ANCA type, was positive. A lung C.T. scan showed a cavita ry tumor. Surgical removal of this tumor evidenced a bronchial squamou s cell carcinoma. Four week after surgery, clinical signs and eosinoph ilia disappeared. After 6 months, ANCA became undetectable. Discussion . Parallelism between the evolution of the cutaneous and articular sym ptomatology and of the cancer are diagnosis of paraneoplastic rheumato id arthritis and paraneoplastic interstitial granulomatous dermatitis. Paraneoplastic rheumatoid arthritis is very unusual and this is the f irst reported case of simultaneously occurring paraneoplastic intersti tial granulomatous dermatitis.