AM report PEARLS 1/25: eosinophilic lung disease and paraneoplastic syndromes of RCC

Take-home point #1: when a patient presents with a new rash after a hospitalization, think about drug reactions (esp from antibiotics, antiepileptics, or allopurinol). The characteristic of the rash can be helpful: painful rashes suggest infection or SJS/TEN, pruritic rashes suggest urticarial and other allergic reactions, and neither painful nor pruritic suggest autoimmune processes.

 

Take-home point #2: RCC as another great mimicker: 1/3 of patients with RCC show s/sx of a paraneoplastic syndrome!! The presence of this is not always a marker of metastatic disease or prognosis, and nephrectomy often leads to resolution. More below and attached.

 

Eosinophilic lung disease (*note, this can be suggested by peripheral eosinophilia + e/o pulmonary parenchymal dz, but you need evidence of LUNG TISSUE eosinophilia by BAL or biopsy to confirm true lung eosinophilia)

  • Infections: Helminthic infections (eg Strongyloides) and nonhelminthic infections (eg cocci, TB)
  • Drugs: NSAIDs, amoxicillin, amiodarone, AEDs, ACEi, others
  • Idiopathic acute eosinophilic pneumonia: usually p/w rapid development of acute respiratory failure in a previously healthy patient
  • Other things: EGPA (Churg Strauss), allergic bronchopulmonary aspergillosis (seen in pts with asthma, CF), hypereosinophilic syndrome

 

Paraneoplastic syndromes in RCC: the great mimicker!!

  • Hypercalcemia is the most common paraneoplastic syndrome – can be from PTHrP or from bony mets
  • Leukemoid reaction (from increased GCSF)
  • Polycythemia: from increased EPO
  • Endocrinopathies: including elevated HCG or ACTH, Cushing’s syndrome, hyper/hypoglycemia
  • More here: http://www.ncbi.nlm.nih.gov/pubmed/16985675

 

Evernote: https://www.evernote.com/shard/s34/sh/ddf9ab8c-c8b9-4f74-9317-42df7ed3ea88/c0453ac5d7b255db895891addd169b5d

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s