Paraneoplastic fasciitis - Panniculitis syndrome: A neurological point of view

Background: A 54-year-old woman who had undergone gastrectomy to treat gastric adenocarcinoma 5 years previously and had since been in remission presented to a neuromuscular clinic complaining of stiffening and painful spasms of the legs and abdomen. Repeat pan-CT scans and gastric biopsy confirmed the recurrence of poorly differentiated signet ring gastric adenocarcinoma. Her symptoms improved remarkably on initiation of chemotherapy and worsened on discontinuation of chemotherapy. Investigations: Neurological examination, MRI of the abdomen and lower extremities, whole-body fluorodeoxyglucose PET, pan-CT scan, electromyography, muscle biopsy, upper gastrointestinal tract radiography, esophagogastroduodenoscopy, and immunophenotyping (paraneoplastic, rheumatological and autoimmune diseases panels). Diagnosis: Paraneoplastic fasciitis-panniculitis syndrome associated with the recurrence of poorly differentiated signet ring gastric adenocarcinoma. Management: Chemotherapy of recurrent gastric adenocarcinoma and symptomatic management of painful spasms.