[Paraneoplastic Bazex acrokeratosis in adenocarcinoma of the stomach].Dtsch Med Wochenschr. 2001 Feb 23; 126(8):203-6.DM
HISTORY AND EXAMINATION
A 58-year-old man presented with a sudden eruption of hyperkeratoses on hands and feet. Alcohol abuse had been present 10 years ago, together with a gastric ulcer. Physical examination was unremarkable, except for plantar bizarre hyperkeratoses especially at the sides of the feet as well as some rhagades with spread to the dorsum of the toes. Similar but less severe hyperkeratoses were found on the palms.
Laboratory investigation was essentially normal. X-rays of the thorax and sinuses as well as a sonography of the stomach revealed, except for a fatty liver, no pathological findings. Gastroscopy revealed a chronic active gastritis on the small curvature of the stomach. Only a second gastroscopy and biopsy revealed an adenocarcinoma of the stomach.
DIAGNOSIS, THERAPY AND COURSE
According to the clinical presentation a paraneoplastic acrokeratosis (Bazex syndrome) was diagnosed. The patient was given high-dose chemotherapy with subsequent stem-cell transplantation and gastrectomy. The skin problems resolved after the first cycles of chemotherapy.
If clinically a paraneoplastic acrokeratosis is suspected extensive search for a malignancy has to be initiated, including a gastroscopy, because rarely, but as in the present case, a carcinoma of the stomach can be the underlying cause.