Chronic urticaria associated with lung adenocarcinoma — a paraneoplastic manifestation: A case report and literature review

Table 1 Results of requested paraclinical tests (blood count and peripheral blood smear)

Parameter	Result	Reference range
Blood count
Leukocytes	22460	5000-10000/mm3
Neutrophils	94.2% (21160)	45%-75%
Lymphocytes	2.5% (570)	30%-40%
Monocytes	2.2% (490)	0%-8%
Eosinophils	0% (0)	0%-5%
Basophils	0.2% (40)	0%-1%
Red blood cells	6.8 million/mm3	3.7-5.1 million/mm3
Hemoglobin	14.9 g/dL	12-14 g/dL
Hematocrit	47.8%	35%-46%
Mean corpuscular volume	69.9 ft	80-100 ft
Mean corpuscular hemoglobin	21.8	27-33 pg
Platelets	366000	150000-450000/mm3
Peripheral blood smear
Red blood cells series	Normal number, morphology preserved	-
Platelets	Normal number, morphology preserved	-
White blood cell series	Normal size, shape, granulations and lobulations	-

Table 2 Results of requested paraclinical tests (urine test, renal function, and other biomarkers in blood)

Parameter	Result	Reference range
Urine test
Color	Yellow	-
Appearance	Slightly turbid	-
Density	1020	1010-1020
pH	6	4.5-7.5
Nitrites	Negative	-
Leukocyte esterase	Negative	-
Protein	Negative	< 30 mg/dL
Glucose	Negative	0-15 mg/dL
Bacteria	+	-
Ketonic bodies	Negative	-
Leukocytes	1-3	1-10 by camp
Red blood cells	2-4	1-5 by camp
Renal function
Blood urea nitrogen	20.1 mg/dL	9-25 mg/dL
Creatinine	1.1 mg/dL	0.7-1.3 mg/dL
Urea	44.08 mg/dL	10-45 mg/dL
Other biomarkers in blood
Troponin	0.01 mg/dL	< 0.01 mg/dL
Creatine phosphokinase	38 mg/dL	28-174 mg/dL
Uric acid	4.2 mg/dL	3.5-7.2 mg/dL
Tumor markers
Alpha fetoprotein	0.50	54.8 U/L
Carcinoembryonic Antigen	1.02	0-3 U/L
CA 19-9	31	0-37 U/L

Table 3 Results of requested paraclinical tests (antibodies and infectious diseases)

Parameter	Result
Antibodies
Antinuclear antibodies IgG	10.92
Anti-RD	2.67
Anti-LA	2.4
Anti-SM	2.23
Anti-RNP	2.18
C-ANCA P-ANCA	Negative
IgE	62.7
RA test	< 30
C3	120 mg/dL (reference range: 90-180 mg/dL)
C4	215.2 mg/dL (reference range: 10-40 mg/dL)
Infectious diseases test
Hepatitis B virus test	Negative
Hepatitis C virus test	Negative
Human Immunodeficiency virus test	Negative
Venereal disease research laboratory test	Negative

Anti-LA: Antibody LA; Anti-SM: Anti-smith antibody; C-ANCA: Antineutrophil cytoplasmic autoantibody, cytoplasmic; IgG: Immunoglobulin G; P-ANCA: Perinuclear anti-neutrophil cytoplasmic antibodies; RA: Rheumatoid factor test; RD: Antibody rhesus-D; RNP: Ribonucleoprotein.

Table 4 Curth's criteria for paraneoplastic dermatoses: Adapted from Garza and Ocampo (2015)

Criteria	Main characteristic	Main findings
Majorcriteria	Concurrent appearance	Dermatosis and malignancy occur simultaneously.
	Parallel evolution	If the malignancy is treated successfully or recurs, the dermatosis follows a similar course.
Minor criteria	Uniformity	A specific malignancy is constantly associated with a specific dermatosis.
	Statistical significance	There is a statistically significant association between malignancy and dermatosis based on case-control studies.
	Rarity	Rarity in the type of skin pathology. Very frequent processes are eliminated because their high prevalence can cause them to be merely coincidental.

Table 5 Classification of paraneoplastic dermatoses: Adapted from Monestier and Richar (2018)

Type of PND	Characteristics
Real dermatoses	Basex paraneoplastic acrokeratosis, migratory necrolytic erythema, gyratum repens erythema, paraneoplastic pemphigus, florid cutaneous papillomatosis, palmar fasciitis and arthritis, acquired lacunar hypertrichosis.
Facultative dermatoses	Acquired ichthyosis, vasculitis, erythroderma, dermatomyositis, filiform hyperkeratosis, Sweet's syndrome, Pyoderma gangrenosum, pruritus, superficial migratory phlebitis.
Controversial dermatoses	Centrifugal annular erythema, Cutaneous vasculitis, necrobiotic xanthogranuloma, primary amyloidosis, scleroderma, porphyria cutanea tardis, bullous pemphigoid, linear IgA dermatitis, Raynaud's phenomenon, urticaria

PND: Paraneoplastic dermatoses.