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Autoimmune Haemolytic Anemia Associated with Testicular Non Seminomatous Germ Cell Tumor (NSGCT): A Unique Para Neoplastic Presentation

Arpit Jain1, Sumit Goyal1, Nivedita Patnaik2, Jitin Goyal3 and Shivashankara Swamy Mathighatta Shivarudraiah1*

Para neoplastic syndromes (PNS) are relatively rare and often an interesting systemic manifestation of malignancy. PNS are remote clinical or biochemical effects triggered by altered immune responses to neoplasm, not explained by the local extension or mass effect. PNS may presage the diagnosis or develop anytime during the course of malignancy. Depending on the organ systems affected PNS may be classified as neurological, endocrine, mucocutaneous and/or hematological.

Anemia is a common complication seen in patients with malignancy and is associated with increased morbidity, poor tolerance to treatment and worse clinical outcomes. Etiology of anemia of malignancy is multifactorial like nutritional, anemia of chronic disease, drug induced, direct involvement of bone marrow, blood loss and hemolytic anemia. Identification of the underlying cause of anemia and appropriate management impacts clinical outcomes. Autoimmune hemolytic anemia (AIHA) as PNS is commonly seen with hematological malignancies but such association with solid malignancies particularly like testicular tumors is very rare. Here we discuss a clinical profile and management of Para neoplastic autoimmune hemolytic anemia in a patient with testicular nonseminomatous germ cell tumor (NSGCT) and review of literature. Here we illustrate an unique Para neoplastic presentation of AIHA in association with testicular NSGCT. Such association needs to be verified after excluding other more common etiologies.