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[Myelodysplastic syndrome associated with polymyalgia rheumatica]
1Division of Hematology, Ehime Prefectural Central Hospital.
Summary
Polymyalgia rheumatica can mask serious hematologic conditions. Elderly patients with polymyalgia rheumatica exhibiting unusual symptoms may have an underlying myelodysplastic syndrome, requiring careful evaluation.
Area of Science:
- Rheumatology
- Hematology
- Internal Medicine
Background:
- Polymyalgia rheumatica (PMR) is an inflammatory condition causing muscle pain and stiffness, typically in older adults.
- PMR is often treated with low-dose corticosteroids like prednisolone.
- Prompt diagnosis and management are crucial for patient outcomes.
Observation:
- A 69-year-old male presented with severe girdle pain, diagnosed as polymyalgia rheumatica.
- Initial treatment with prednisolone (20 mg/d) resolved his muscle pain within 3 weeks.
- After 5 months, the patient developed pancytopenia, indicating a significant blood disorder.
Findings:
- Bone marrow aspirate revealed hypercellularity, trilineage dysplasia, and 7% blasts.
- The patient was diagnosed with myelodysplastic syndrome (MDS), refractory anemia with excess blasts subtype.
- This suggests a potential link between initial PMR diagnosis and subsequent MDS development.
Implications:
- Elderly patients with polymyalgia rheumatica require vigilant monitoring for signs inconsistent with typical PMR.
- Underlying hematologic malignancies, such as myelodysplastic syndromes, should be considered in such cases.
- Early detection of hematologic issues in patients initially diagnosed with PMR can improve prognosis.