Dermatology Online Journal

Urticaria and lip fasciculation may be prodromal signs of brain malignancy
Sadollah Shamsadini¹, Majid Varesvazirian², and Ayeh Shamsadini¹
Dermatology Online Journal 12 (3): 23

Department of dermatology, Kerman University of Medical Sciences, Kerman Iran.shamsadini@yahoo.com
2. Pediatric Specialist, Kerman University of Medical Sciences, Kerman Iran

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Abstract

The association of urticaria and cancer usually is seen with lymphoreticular system malignancies. Recalcitrant intra-nostril pruritus has been associated with fourth-ventricle tumors of the brain. Rarely, urticaria has been described with cancer of the lung, usually small-cell adenocarcinoma. We describe a girl who suffered with chronic urticaria for 3 months before lip fasciculation began to be observed. CT scan revealed a brain tumor adjacent to the cerebellum, which was diagnosed as astrocytoma grade II. Because of the location, the tumor was not operable, but after one course of radiotherapy, both the urticaria and lip fasciculation disappeared.

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Clinical synopsis

A 12-year-old girl was referred to the dermatology clinic for itchy erythematous macules, papules, and plaques on her trunk, buttocks and proximal extremities. The recurrent eruptions were often figurate. The clinical diagnosis was urticaria of unknown etiology. She took no medications prior to the onset of urticaria and since that time had been administered several types of antihistamines. After partially effective antihistamine therapy for 3 months, she began to exhibit prominent fasciculation of her lower lip. She had no history of headache, vomiting, or vertigo. A mass was identified adjacent to the cerebellum by CT scan. Fine-needle aspiration of the tumor produced a pathological diagnosis of grade-II astrocytoma. Because of the location of the tumor it was not operable, but radiotherapy was begun; after one course the urticarial eruptions and lip fasciculation ceased. Follow up 3 years after her full course of radiotherapy revealed no recurrence of astrocytoma, urticaria, or fasciculation.

Discussion

We reviewed the literature regarding the association of malignant diseases with chronic urticaria [1, 2, 3, 4, 5, 6, 7]. The Swedish cancer registry, in Stockholm, reported malignancies in their study population of 1155 patients and compared this with the expected number of malignancies, calculated on the basis of age- and sex-standardized incidence data [2]. A malignancy was diagnosed in 36 patients with urticaria and the expected number of malignancies was 41. In 23 patients the malignancy appeared during the same year as the onset of urticaria or later. The expected number was 25.6. One must conclude that chronic urticaria is not statistically associated with malignancy in general.

Although associations of intra-nostril pruritus with brain tumors occurs in about half of the involved cases [5], the association of urticaria with astrocytoma of the cerebellum has not been reported. It appears that although cancers are uncommonly associated with chronic urticaria there are occasional cases where this appears to be a true association. Therefore, a thorough history, physical examination, and followup are important.

References

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2. Lindelof B, Sigurgeirsson B, Wahlgren CF, Eklund G. Chronic urticaria and cancer: an epidemiological study of 1155 patients. Br J Dermatol. 1990 Oct;123(4):453-6. PubMed

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5. Adreev VC, Petkov I. Skin manifestations associated with tumours of the brain. Br J Dermatol. 1975 Jun;92(6):675-678. PubMed

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