Report Describes Case of Woman with CAD-Breast Cancer Connection

Physicians have described the rare case of a woman with cold agglutinin disease (CAD) associated with advanced breast cancer.

Her case was described in a case report study, “Cold autoimmune hemolytic anemia: a rare association with triple-positive breast cancer,” published in the Journal of Community Hospital Internal Medicine Perspectives.

CAD is a form of autoimmune hemolytic anemia (AIHA) in which autoantibodies attack and destroy red blood cells at low body temperatures. The disorder is often linked to other autoimmune diseases or infectious disorders, and is rarely associated with the use of certain medications or solid cancers, including breast cancer.

In this report physicians in Pakistan, in collaboration with colleagues in the U.S., described the rare case of a woman with CAD associated with metastatic breast cancer — an advanced form of the disease in which cancer cells already have spread from the breast into other regions in the body.

The 45-year-old woman of Asian ancestry arrived at the hospital complaining of fever, extreme fatigue, shortness of breath, and other signs and symptoms of anemia. She had a past medical history of diabetes and high blood pressure, and a family history of cancer (chronic myeloid leukemia in a first-degree relative).

Lab tests detected high levels of monospecific antibodies of C3 protein (C3d), one of the members of the complement system that is overactive in patients with AIHA, on the surface of red blood cells. That confirmed the diagnosis of CAD. (The complement system comprises a set of more than 20 blood proteins that are part of the body’s immune defenses.)

To determine the underlying cause of CAD, physicians performed computed tomography (CT) scans that revealed she had several enlarged lymph nodes in her neck and armpits.

Physicians then performed an ultrasound-guided true-cut biopsy over one of the enlarged lymph nodes on her left armpit, “which showed the presence of tumor cells arranged in cords and clusters.”

Further staining tests suggested these tumor cells were breast cancer cells, which was confirmed by subsequent tests showing they were positive for a series of female hormone receptors, including estrogen and progesterone, and human epidermal growth factor receptor 2 (HER2).

These observations led to the diagnosis of CAD associated with triple-positive breast cancer. Following diagnosis, she was started on pulse therapy of corticosteroids to manage CAD, and on chemotherapy and radiotherapy to treat breast cancer.

“The association of AIHA with solid tumors is rare, but its association with metastatic breast cancer is the rarest among all solid malignancies. So, whenever we come across a patient with AIHA, in addition to treating it with steroids and other immunosuppressive therapeutic agents, the primary cause should be figured out and managed accordingly,” the physicians concluded.