Polymyalgia Rheumatica Revealing a Lymphoma: A Two-Case Report

Abstract

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.

Polymyalgia rheumatica in 18-fluorodeoxyglucose-positron-emission-tomography/computed tomography

“…In 4 % (n = 10) der Untersuchungen kam ein Malignom zur Darstellung, davon fünf Lymphome, drei pulmonale Malignome, eine diffuse Metastasierung mit unklarem Primarius, sowie ein Rezidiv eines Mammakarzinoms. Auch Patienten mit PMR sind von malignen Erkrankungen betroffen [29]…”

Usefulness of 18F-Fluorodeoxyglucose Positron Emission Tomography in Diagnosing Polymyalgia Rheumatica and Large-Vessel Vasculitis: A Case-Control Study

“…However, the 2012 ACR/EULAR classification criteria do not include the use of this imaging technique [10]. Additionally, some studies have reported non-negligible vascular hyperfixation rates-referred to as associated large-vessel vasculitis (LVV) (11-60.7%)-in patients with PMR [12,14,15] or the possibility of an underlying neoplasia in the setting of paraneoplastic PMR [16,17].…”