This report describes a patient who presented with an unusual polyarthritis syndrome. After extensive evaluation, squamous cell carcinoma of the lung was diagnosed. During the course of the illness, the patient developed vasculitic features and "rheumatoid-like" nodules. Two months after the administration of combined-modality therapy for stage IIIA non-small cell lung carcinoma, the signs and symptoms of polyarthritis and vasculitis had disappeared completely. Ten months later, the patient remains in clinical remission. This is the first published report of simultaneous vasculitic and polyarticular manifestations in a patient with carcinoma polyarthritis.
Nonhematologic malignancies may involve joints either by direct invasion or by a paraneoplastic effect. Breast and lung primary cancers are the most frequent to metastasize to articular structures, often to the knees (1). Polyarticular metastases infrequently predate discovery of the cancer; severe destruction on radiographs may be a clue (2). Paraneoplastic arthropathies are among the musculoskeletal manifestations of cancer. Rarely, polyarthritis is the presenting sign of malignancy. Although the mechanism is unclear, the polyarthritis often improves with treatment of the underlying malignancy. Distinguishing features of "carcinoma polyarthritis" include sudden onset at an older age, asymmetry, and predominant involvement of the legs and sparing of wrists and small joints. Usually absent are rheumatoid nodules, rheumatoid factor, and a family history of rheumatic disease. Herein we report the case of a woman with an unusual polyarthritis syndrome with associated vasculitis. This case depicts carcinoma poly-