Abstract YO4
Case summary
A 70-year-old female initially presented in the clinic for a history of skin thickening, fatigue, weight loss, shortness of breath, and Raynaud’s phenomenon. She consulted an immunologist, and the workup revealed a positive test for antinuclear antibody (ANA) and anti-polymerase III antibody. A diagnosis of systemic sclerosis was made due to the presence of a non-specific interstitial change pattern on the thoracic CT scan. The patient was initially treated with steroids and non-steroidal anti-inflammatory drugs. However, the disease progressed, and treatment was shifted to mycophenolate mofetil and Nintedanib. Two years after the diagnosis, she developed five liver nodules, which were positive for carcinoma of breast cancer origin, hence the diagnosis of metastatic breast carcinoma. The first line of treatment with ribociclib and letrozole was initiated.
Six months after the oncologic treatment initiation, there was a significant clinical improvement in the symptoms, partial response of the liver nodules with no metabolic expression, and stable lung interstitial changes. Currently, the patient continues her breast cancer and systemic sclerosis maintenance treatment. The lack of response to conventional systemic sclerosis therapy but improvement with the underlying malignancy treatment suggests the case’s possible paraneoplastic origin. This case report may further improve awareness of the natural course of the disease, preventing a potential cancer treatment delay.