Immunohistochemistry was weakly estrogen receptor (ER) positive, weakly progesterone receptor (PR) positive, and human epidermal growth factor 2 (HER2) negative

Immunohistochemistry was weakly estrogen receptor (ER) positive, weakly progesterone receptor (PR) positive, and human epidermal growth factor 2 (HER2) negative. undergoing bilateral mastectomies?and receiving anastrozole, prednisone,?and rituximab. We suspect the mastectomies and immune modulating therapies have not had an effect on her chorea because her P/Q and N-type V-G calcium channel binding antibodies may be intracellular. This case of paraneoplastic chorea associated with breast malignancy is usually unusual. To the best of our knowledge, only one other case of paraneoplastic chorea associated with breast cancer has been reported in the English literature. strong class=”kwd-title” Keywords: chorea, paraneoplastic syndrome, paraneoplastic chorea, n type voltage gated calcium channel binding antibodies, p/q type voltage gated calcium channel binding antibodies, paraneoplastic antibodies, breast cancer Introduction Paraneoplastic neurologic?syndromes are a group of immune-mediated, cancer-associated disorders affecting the nervous system [1]. While the mechanisms underlying these syndromes are not comprehended fully, they may be caused by an immune response against common antigens expressed by the cancer and nervous system?[1]. Well-known paraneoplastic syndromes include P/Q-type voltage-gated (V-G) calcium channel antibodies in Lambert-Eaton myasthenic syndrome?[2]?and N-methyl-D-aspartate (NMDA) receptor antibodies in anti-NMDA receptor encephalitis?[3]. The P21 incidence of paraneoplastic syndromes varies with the type of tumor. A common paraneoplastic syndrome is usually myasthenia gravis, occurring in approximately 15% of individuals with thymoma?[4]. For most solid tumors, the paraneoplastic disorders are less common, with an incidence of 1%?[5]. We describe the course of an elderly patient with paraneoplastic chorea associated with breast malignancy. Case presentation In December 2012, a 70-year-old woman presented with the chief complaint of shaking head movements. The movements began one month previously, shortly after she began taking hydroxychloroquine for seropositive rheumatoid arthritis (RA). In addition to RA, the patient had a past medical history of atrial fibrillation, cardioembolic cerebrovascular accident, two transient ischemic attacks, Sj?grens syndrome, pseudogout, calcium pyrophosphate disease, osteoarthritis, pacemaker placement, left-sided multinodular goiter, osteoporosis, chronic hypertension, heart failure with preserved ejection function, recurrent bilateral lower extremity deep vein thromboses, iron deficiency anemia, Desmopressin Acetate anxiety disorder, major depressive disorder, and dyslipidemia. She did not smoke tobacco, drink alcohol, or use illicit drugs. She danced once or twice a week to maintain physical Desmopressin Acetate fitness. Her family history was not contributory. She did not have allergies. Her medications included atorvastatin, carvedilol, Desmopressin Acetate cyclosporine, docusate, ergocalciferol, ferrous sulfate, folic acid, furosemide, losartan, melatonin, methotrexate, omeprazole, polyethylene glycol, prednisone, hydroxychloroquine, and warfarin. Blood pressure was 135/72 mmHg, heat was 97.7 Fahrenheit (38.6 Celsius), and body mass index was 41.05 kg/m2. She was alert and oriented to person place and time, and not in acute distress. Cranial nerves 2C12, and sensation to pinprick, vibration, and joint position were intact. Reflexes were 2+ at all the tendons, and strength was 5/5 in all the extremities.?Gait was ataxic and she had choreiform movements affecting her head, upper extremities, and lower extremities. There was some dysmetria with finger-to-nose testing.?The heart had normal rate and rhythm with a holosystolic murmur in the aortic region. The pulmonary, abdominal, and integumentary exams were unremarkable. Arrangements were made to contact the patient’s rheumatologist to determine if the head movements were related to hydroxychloroquine?and obtain medical records from outside facilities. Results from a computed tomography (CT) scan of.