Rhinopharyngeal carcinoma-associated paraneoplastic syndrome resembling eosinophilia-myalgia syndrome: a case report

Hypereosinophilic syndromes represent frequently a diagnostic challenge for the Clinician; they can be associated with allergic, parasitic, connective tissue and neoplastic diseases but not infrequently some of them remain unexplained despite a careful evaluation, and so termed as «idiopathic». We describe the case of a hypereosinophilic paraneoplastic syndrome presenting with features of an Eosinophilia-Myalgia Syndrome. A 47-year-old man came to our observation complaining of painful arthromyalgias and muscular hypostenia for several months. His past hystory was unremarkable; he denied use of preparation containing 1-tryptophan or related drugs. On examination he revealed muscular pain under pressure of the limb, belt and dorsal muscles with a slight functional decreasing. Left palpebral ptosis was present involving V, VI and VII pairs of the omolateral cranial nerves. No other pathologic symptoms were found; arterial pressure, ECG and EMG were normal. Laboratory studies revealed CPK, LDH, ALT, AST, aldolase, serum protein electrophoresis, immunoglobulins and complement fractions normal; FR, ANA and ANCA absent, ESR 35 mm/h, C reactive protein 8.6 mcg/ml, Hb 10 g/dl, RBC 3.5×106/mm3, WBC 6400/mm3 (E 40%= 2600/mm3), PLT 130.000/mm3; parasitologic stool test was negative. Osteomyelic examination revealed: hypercellularity of the granulocytic series with immature and intermediate elements with an almost exclusive eosinophilic differentiation; normal erythrpoiesis and megakaryocytopoiesis. ENT examination revealed: outcomes of chronic otitis, perforation of the posterior quadrants and chronic inflammation of both the mastoidal antrum and the tympanum. Cranial MR disclosed: intra and extracranial epansive lesion with erosion of the skull base. Histologic examination of the rhynopharyngeal tissue showed the presence of undifferentiated-cell rhynopharyngeal carcinoma. Total remission of the clinical and hematological picture was observed after 2 cycles of chemoterapy and 9 courses of radiotherapy with linear accelerator. Remission was still present ten months after treatment. This case suggests to take into account the possible paraneoplastic nature of certain hypereosinophilic syndromes.