CLINICAL IMAGE
Doctor, I am sweating on just one side of my body: unilateral hyperhidrosis associated with mesothelioma Eswaran Waran Royal Darwin Hospital, Rocklands Drive, Tiwi, NT 0810, Australia
Correspondence Eswaran Waran, Royal Darwin Hospital, Rocklands Drive, Tiwi, NT 0810, Australia. Tel/Fax: +61 8 89228888; E-mail: [email protected] Funding Information No sources of funding were declared for this study. Received: 21 January 2016; Accepted: 20 March 2016
Key Clinical Message Unilateral hyperhidrosis is rare and should prompt a thorough review for potentially serious underlying etiologies. Available treatments for unilateral hyperhidrosis secondary to mesothelioma are limited and its presence as a symptom usually signifies advanced disease and a poor prognosis. Keywords Hyperhidrosis, lung cancer, mesothelioma, palliative.
Clinical Case Reports 2016; 4(5): 533–534 doi: 10.1002/ccr3.557
Question: Can you name some possible causes for the image demonstrated? Answer: The potential differential diagnosis for unilateral hyperhidrosis should include hypothalamic tumors,
Figure 1. Contrast CT of the chest demonstrating a soft tissue mass in the L aorto-vertebral recess.
cerebral infarction, encephalitis, syringomyelia, trauma, neuritis, cervical rib, and intrathoracic malignancy. A 55-year-old man with a childhood history of asbestos exposure presented with left-sided chest pain. CT imaging suggested pleural-based soft tissue deposits, including one in the left aorto-vertebral recess. Biopsy was diagnostic of malignant mesothelioma of sarcomatoid type. Disease progression despite radiotherapy and chemotherapy was
Figure 2. Iodine was applied to the skin of the trunk and allowed to dry. Cornflour was applied. The hyperhidrotic area turned from yellow to violet/dark blue. This image was captured after 5 min in humid conditions. It shows unilateral hyperhidrosis on the contralateral side of the lesion. Please note, for patient comfort the test was administered on only a small portion of the back.
ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
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Unilateral Hyperhidrosis
associated with the development of profound hyperhidrosis on the contralateral side. No new right-sided paravertebral disease was evident on repeat staging (Fig. 1). Figure 2 demonstrates the outcome of the Minor sweat test. Unilateral hyperhidrosis secondary to underlying intrathoracic malignancy has rarely been reported in the literature. To explain contralateral hyperhidrosis in the event of ipsilateral damage to the sympathetic chain, Brodoehl et al. have suggested a loss of negative feedback on the hypothalamus (resultant in increased positive feedback and sweating on the contralateral side) [1]. Unilateral hyperhidrosis in mesothelioma usually signifies advanced disease and has a poor prognosis [2].
Acknowledgments No relevant acknowledgments.
E. Waran
Ethical Approval The relevant institution does not require ethics approval. The manuscript conforms to standards currently applied in Australia.
Consent Consent is provided in the format used by the BMJ. The patient has read the final document and indicated as such on the provided consent form. In addition, the manuscript has been completely anonymised. References 1. Brodoehl, S., O. W. Witte, and A. Guenther. 2013. Compensatory quadrant-hyperhidrosis after contralateral intrathoracic surgery: a case report. J. Med. Case Rep. 7:24. 2. Fast, A. 1977. Reflex sweating in patients with spinal cord injury: a review. Arch. Phys. Med. Rehabil. 58:435–437.
Conflict of Interest None declared.
534
ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
Doctor, I am sweating on just one side of my body: unilateral hyperhidrosis associated with mesothelioma Eswaran Waran Royal Darwin Hospital, Rocklands Drive, Tiwi, NT 0810, Australia
Correspondence Eswaran Waran, Royal Darwin Hospital, Rocklands Drive, Tiwi, NT 0810, Australia. Tel/Fax: +61 8 89228888; E-mail: [email protected] Funding Information No sources of funding were declared for this study. Received: 21 January 2016; Accepted: 20 March 2016
Key Clinical Message Unilateral hyperhidrosis is rare and should prompt a thorough review for potentially serious underlying etiologies. Available treatments for unilateral hyperhidrosis secondary to mesothelioma are limited and its presence as a symptom usually signifies advanced disease and a poor prognosis. Keywords Hyperhidrosis, lung cancer, mesothelioma, palliative.
Clinical Case Reports 2016; 4(5): 533–534 doi: 10.1002/ccr3.557
Question: Can you name some possible causes for the image demonstrated? Answer: The potential differential diagnosis for unilateral hyperhidrosis should include hypothalamic tumors,
Figure 1. Contrast CT of the chest demonstrating a soft tissue mass in the L aorto-vertebral recess.
cerebral infarction, encephalitis, syringomyelia, trauma, neuritis, cervical rib, and intrathoracic malignancy. A 55-year-old man with a childhood history of asbestos exposure presented with left-sided chest pain. CT imaging suggested pleural-based soft tissue deposits, including one in the left aorto-vertebral recess. Biopsy was diagnostic of malignant mesothelioma of sarcomatoid type. Disease progression despite radiotherapy and chemotherapy was
Figure 2. Iodine was applied to the skin of the trunk and allowed to dry. Cornflour was applied. The hyperhidrotic area turned from yellow to violet/dark blue. This image was captured after 5 min in humid conditions. It shows unilateral hyperhidrosis on the contralateral side of the lesion. Please note, for patient comfort the test was administered on only a small portion of the back.
ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
533
Unilateral Hyperhidrosis
associated with the development of profound hyperhidrosis on the contralateral side. No new right-sided paravertebral disease was evident on repeat staging (Fig. 1). Figure 2 demonstrates the outcome of the Minor sweat test. Unilateral hyperhidrosis secondary to underlying intrathoracic malignancy has rarely been reported in the literature. To explain contralateral hyperhidrosis in the event of ipsilateral damage to the sympathetic chain, Brodoehl et al. have suggested a loss of negative feedback on the hypothalamus (resultant in increased positive feedback and sweating on the contralateral side) [1]. Unilateral hyperhidrosis in mesothelioma usually signifies advanced disease and has a poor prognosis [2].
Acknowledgments No relevant acknowledgments.
E. Waran
Ethical Approval The relevant institution does not require ethics approval. The manuscript conforms to standards currently applied in Australia.
Consent Consent is provided in the format used by the BMJ. The patient has read the final document and indicated as such on the provided consent form. In addition, the manuscript has been completely anonymised. References 1. Brodoehl, S., O. W. Witte, and A. Guenther. 2013. Compensatory quadrant-hyperhidrosis after contralateral intrathoracic surgery: a case report. J. Med. Case Rep. 7:24. 2. Fast, A. 1977. Reflex sweating in patients with spinal cord injury: a review. Arch. Phys. Med. Rehabil. 58:435–437.
Conflict of Interest None declared.
534
ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
