Abstract

Subacute cutaneous lupus erythematous (SCLE) is a clinical phenotype of cutaneous lupus erythematous (CLE) associated with Ro/SSA autoantibodies and classically drug-related triggers; however, paraneoplastic etiologies have been rarely related to internal malignancies. Here we report a case of paraneoplastic SCLE with extensive mucositis and esophagitis due to an underlying small cell lung carcinoma. The patient initially presented as a 62 year old female with a 40 year smoking history who had a 2 month history of pruritic annular lesions involving the upper extremities and torso in addition to mucosal erosions that limited her oral intake. Cutaneous and mucosal biopsies were consistent with a vacuolar interface dermatitis. Serology revealed an elevated ANA and SSA autoantibodies. Direct immunofluorescence (DIF) showed grains of IgG around the basal and suprabasal epidermal cells. Indirect immunofluorescence for paraneoplastic pemphigus was negative. Esophagogastroduodenoscopy showed esophageal involvement of her mucositis. CT of the chest revealed a 4.9cm left hilar mass with biopsy consistent with small cell lung carcinoma. Her cutaneous and mucosal disease were treated symptomatically with oral steroids but rebound occurred after tapering. Remarkedly, these manifestations resolved after completion of chemotherapy and radiation for her underlying lung carcinoma. Although exceedingly rare, SCLE has been associated with a paraneoplastic etiology particularly small cell lung carcinoma. This highlights the need for extensive clinicopathologic correlation required for extensive mucocutaneous eruptions. Additionally, this case is unique as the patient had extensive oral and esophageal involvement that could mimic paraneoplastic pemphigus.

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