Paraneoplasic syndrome: insidious unspecific constellation of symptoms – a case report

Background: Recent medical advances improved understanding, diagnosis, and treatment of paraneoplastic syndromes. These syndromes may affect distinct organ systems mostly respiratory. Patients may present with autonomic neuropathy prior to diagnosis of cancer or at the time of diagnosis, like abnormal gastrointestinal motility. Unspecific symptoms like cough and asthenia should not be neglected mainly if associated with paraneoplasic flags. Description: Male 79-year-old, caucasian, married, retired, phase VIII of Duval´s cycle, medium Graffar´s (III/IV), no familiar risk, hypertension and ex-smoker (90 pack/year smoking history) presented with asthenia, adynamia, cough and haemoptoic sputum. Thorax x-ray shown enlargement of cardio thoracic index, which had been explained by his age. After a severe constipation episode, an abdominal tomography showed a pneumonia and therapy was established. Despite treatment, the inflammatory markers and clinical condition evolved and he became with fever as well as lung related symptoms got worsen. Another thorax x- ray was performed and pointed out a caveated image with an air fluid level. Thorax tomography confirmed a proliferative mass and added additional information – 2 metastatic lesions in ribs and mediastinal lymphadenopathy. The bronchoscopy reveals a necrotic infiltrative lesion of right inferior lobar bronchus. Conclusion: This clinical report states the importance of careful evaluation with unspecific symptoms and signs. More disturbances over time reveal a decreased general wellbeing that is perceived and followed by family physician.