Hodgkin's lymphoma initially presenting with polymyalgic symptoms: a case report

Şahin, Mehmet; Alanoğlu, Güçhan; Aksu, Oğuzhan; Tunc, Sevket Ercan; Kapucuoğlu, Nilgün; Yener, Mahmut

doi:10.1007/s10165-006-0557-4

Cited by 5 publications

(2 citation statements)

References 10 publications

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“…This association has been described in the initial stage of the symptoms and only three other cases are described in the PubMed database [8–10]. At the same time, it is established that there is a risk of lymphoma in case of PMR [6, 7].…”

Section: Discussionmentioning

confidence: 96%

Polymyalgia Rheumatica Revealing a Lymphoma: A Two-Case Report

Verhoeven

Guillot

Chouk

et al. 2016

Case Reports in Rheumatology

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Introduction. Polymyalgia rheumatica (PMR) is one of the most common inflammatory rheumatism types in elderly population. The link between cancer and PMR is a matter of debate. Methods. We report two cases of PMR leading to the diagnosis of lymphoma and the growing interest of PET-TDM in this indication. Results. A 84-year-old man known for idiopathic neutropenia presented an inflammatory arthromyalgia of the limb girdle since one month. Blood exams highlighted the presence of a monoclonal B cell clone. Bone marrow concluded to a B cell lymphoma of the marginal zone. He was successfully treated with 0.3 mg/kg/d of prednisone, and response was sustained after 6 months. A 73-year-old man known for prostatic neoplasia in remission for 5 years presented arthromyalgia of the limb girdle since one month. PET-CT revealed bursitis of the hips and the shoulders, no prostatic cancer recurrence, and a metabolically active iliac lymphadenopathy whose pathologic exam concluded to a low grade follicular lymphoma. He was successfully treated with 0.3 mg/kg/d of prednisone. Conclusion. These observations may imply that lymphoma is sometimes already present when PMR is diagnosed and PET-CT is a useful tool in the initial assessment of PMR to avoid missing neoplasia.

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Section: Discussionmentioning

confidence: 96%

Polymyalgia Rheumatica Revealing a Lymphoma: A Two-Case Report

Verhoeven

Guillot

Chouk

et al. 2016

Case Reports in Rheumatology

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“…In the case presented herein, the reason for increased 18F-FDG uptake by the large joints is unclear, but might be related to lymphoma-associated polymyalgia symptoms that occur as a paraneoplastic syndrome. 12 Certain cellular risk factors, such as intercellular adhesion molecule 1 expression and the nuclear factor-κB1 promotor insertion/deletion polymorphism, -94ins/delATTG, may lead to the proliferation of mature B-cells that secrete multiple cytokines, which might contribute to the PMR-like presentation. 13 – 16 Interestingly, some of these cytokines can act as independent prognostic markers for DLBCL.…”

Section: Discussionmentioning

confidence: 99%

Polymyalgia rheumatica-like presentation in a case of diffuse large B-cell lymphoma: a diagnostic pitfall

et al. 2021

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Diffuse large B-cell lymphoma (DLBCL) commonly presents with systemic manifestations including fever, weight loss, and night sweats. Uncommonly, patients with DLBCL can present with musculoskeletal manifestations mimicking polymyalgia rheumatica (PMR). Herein, the case of a 61-year-old woman who presented with pain in the bilateral shoulders, arms, hands, knees, pelvic girdle, and neck with bouts of fever, is presented. Laboratory workup for infectious and connective tissue diseases was non-revealing, except for elevated inflammatory markers. A positron emission tomography (PET)/computed tomography (CT) scan was suggestive of PMR, but also revealed enlarged lymph nodes initially thought to be reactive in nature. However, a lymph node biopsy showed findings consistent with DLBCL. This case highlights the importance of a thorough investigational workup when cases with features of PMR do not meet the proper criteria for this diagnosis to be made, in order not to miss a hematopoietic neoplasm with a PMR-like presentation.

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If at first you don't succeed: Try, try again

et al. 2011

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A 51-year-old gentleman presented to a rheumatologist with a 3 week history of fevers, diarrhea, arthralgias, and generalized pruritis. Blood work revealed mild anemia (hemoglobin 13.5 g/dL). The erythrocyte sedimentation rate (ESR) was within normal limits.Given the acuity of onset, rash, and arthralgias, parvovirus B19 was suspected. Cytomegalovirus, Epstein Barr virus, adenovirus, and coxsackievirus were also possible given these presenting signs and symptoms. Systemic lupus erythematosus, rheumatoid arthritis, adult onset Still's disease, or another connective tissue disease could not be excluded. A reactive gastrointestinal disorder was less likely, but possible considering the history of diarrhea.Over the following 2 weeks, the patient's clinical condition deteriorated and he presented to an emergency department. His temperature was 99.5 degrees Fahrenheit and his pulse was 115 bpm. All other vital signs were within normal limits. The physical examination revealed a lacy macular rash over the arms and anterior chest wall. There was no palpable lymphadenopathy or organomegaly.The patient reported a 3 week history of weight loss, but denied chills or night sweats. He had no risk factors for human immunodeficiency virus infection (HIV) or hepatitis. Travel history included trips to Cuba in the year preceding presentation.Laboratory testing revealed elevated liver transaminases (aspartate aminotransferase (AST) 69 U/L, alanine aminotransferase (ALT) 182 U/L, gamma glutamyl transferase (GGT) 95 U/L), and evidence of systemic inflammation (C-reactive protein (CRP) 64 mg/L, ESR 25 mm/hr, ferritin 328 lg/L). Serum lactate dehydrogenase (LDH) (357 U/L) and bilirubin were elevated (total bilirubin peaked at 92 lmol/L, direct at 92 lmol/L). A complete blood count at admission to hospital revealed hemoglobin of 11 g/dL (Mean corpuscular volume (MCV) 86 fL), platelets of 69 3 10 9 /L, and a white blood cell count of 2.3 3 10 9 /L, with a normal white cell differential.The patient looked distinctly unwell, with new pancytopenia, hyperbilirubinemia, elevated liver enzymes, and signs of systemic inflammation. Infection was suspected, but in the absence of intravenous drug use, high risk sexual behavior, or blood transfusions, HIV, or hepatitis was unlikely. With no history of immunosuppression or evidence of pulmonary pathology cytomegalovirus infection was improbable. Bacterial infections, including Streptococcus pyogenes, syphilis, bartonella, or mycobacteria were considered. The presenting symptoms were not characteristic of a specific connective tissue disease.Microbiologic cultures from blood, urine, and cerebral sinus fluid were negative for bacteria, fungi, and acidfast bacilli. Immune serology including antinuclear antibody, double stranded DNA, perinuclear antineutrophil cytoplasmic antibody, cytoplasmic antineutrophil cytoplasmic antibody, anti-smooth muscle, and assays for extractable nuclear antigens (anti-Ro, anti-La, anti-Scl-70, and anti-Jo-1 antibodies) were normal. Complement levels were decreased (C3 5 0...

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Hodgkin's lymphoma initially presenting with polymyalgic symptoms: a case report

Cited by 5 publications

References 10 publications

Polymyalgia Rheumatica Revealing a Lymphoma: A Two-Case Report

Polymyalgia Rheumatica Revealing a Lymphoma: A Two-Case Report

Polymyalgia rheumatica-like presentation in a case of diffuse large B-cell lymphoma: a diagnostic pitfall

If at first you don't succeed: Try, try again

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