A Case of Primary Bone Marrow Diffuse Large B-cell Lymphoma Presenting with Polyarthritis

Abstract

Polyarthritis is a common manifestation of rheumatologic disorders; however, paraneoplastic arthropathies also arise as polyarthritis or polymyalgia, particularly in patients with myelomas, lymphomas, acute leukemia, and solid tumors. Because paraneoplastic syndromes, in some instances, might be manifested before a cancer diagnosis, they are difficult to diagnose and are often misdiagnosed. We experienced a 63-year-old female patient who had nonspecific arthritis on both hands and feet accompanied by fever. She had been diagnosed as rheumatoid arthritis and treated with prednisolone and disease modifying anti-rheumatic drugs (DMARDs) including methotrexate and anti-tumor necrosis factor agents. Her arthritis did not respond with anti-rheumatic treatment and diffuse large B-cell lymphoma was diagnosed by bone marrow biopsy. After 6 cycles of chemotherapy, her arthritis was improved as well as underlying lymphoma. (J Rheum Dis 2016;23:256-260)

Bone marrow limited diffuse large B-cell lymphoma following prolonged immunosuppressive therapy with methotrexate and corticosteroids

“…A literature search for arthritis associated with PBM-DLBCL identified only one report where a patient with seronegative polyarthritis developed bone marrow limited high-grade NHL. [ 4 ] Due to the extreme rarity of PBM-DLBCL, at present, these patients are managed similar to those with DLBCL-NOS with R-CHOP chemotherapy. The possibility that prolonged use of methotrexate and steroids may have altered the characteristics of DLBCL in our patient should be considered.…”