Leptomeningeal Carcinomatosis and Myelophthisic Anemia as Initial Manifestations of Metastatic Lobular Breast Cancer

Breast cancer can spread to the brain and bone, usually presenting as parenchymal and osteoblastic lesions, respectively. We present a unique case of a 59-year-old woman undergoing treatment for invasive lobular breast cancer who presented with nausea, vomiting, headache, and generalized weakness. Her clinical presentation and subsequent evaluation led to a discovery of leptomeningeal carcinomatosis and myelophthisic anemia presenting simultaneously as her initial metastases. She was treated with weekly paclitaxel and intrathecal methotrexate, with noted cerebrospinal fluid response. She continues to follow up with the oncology clinic.