title: Metastatic breast cancer presenting as fever, rash, and arthritis.
abstract: BACKGROUND
  Fever can be the presenting symptom of metastatic breast carcinoma, but the combination of fever, polyarthritis, and an erythematous rash as a paraneoplastic syndrome in breast carcinoma is very rare.
  
  
  METHODS
  The clinical course of a 49-year-old female with a history of ductal breast carcinoma who presented with fever of unknown origin, polyarthritis, and an erythematous rash is described. Moreover, cytokine measurements were performed.
  
  
  RESULTS
  Initially, despite extensive evaluation, a diagnosis could not be made. Six weeks after the onset of symptoms, a right axillary lymph node became palpable and the diagnosis of relapsing breast carcinoma was made. Chemotherapy led to defervescence and disappearance of the symptoms. Elevated interleukin-6 and interleukin-1 receptor antagonist concentrations were found.
  
  
  CONCLUSIONS
  To the authors' knowledge, the severe paraneoplastic signs encountered in this patient have not been described in breast carcinoma. The presentation is even more remarkable in view of the relatively small visible tumor mass.
authors.affiliation: Department of Medicine, University Hospital St. Radboud, Nijmegen, The Netherlands.
authors.forename: J P
authors.initials: JP
authors.lastname: Drenth
authors.forename: E H
authors.initials: EH
authors.lastname: de Kleijn
authors.forename: P H
authors.initials: PH
authors.lastname: de Mulder
authors.forename: J W
authors.initials: JW
authors.lastname: van der Meer
mesh_terms: D001168:Arthritis / Q000209:etiology*; D001943:Breast Neoplasms / Q000150:complications*; D004890:Erythema / Q000209:etiology*; D005260:Female; D005335:Fever of Unknown Origin / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D010257:Paraneoplastic Syndromes / Q000209:etiology*