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Polymyalgia rheumatica and breast cancer
Michael P Keith1, William R Gilliland
1Rheumatology Service, Walter Reed Army Medical Center, Washington, DC 20307, USA. mpkeith@bethesda.med.navy.mil
Summary
Polymyalgia rheumatica can rarely signal breast cancer. This case highlights the importance of suspecting malignancy in patients with atypical polymyalgia rheumatica symptoms, especially those unresponsive to steroids.
Area of Science:
- Oncology
- Rheumatology
- Medical Diagnostics
Background:
- Polymyalgia rheumatica (PMR) is an inflammatory condition typically affecting older adults.
- Malignancy is an uncommon cause of PMR, but early detection is crucial.
- Breast cancer, particularly infiltrating ductal carcinoma, can present with varied symptoms.
Observation:
- A patient presented with symptoms mimicking polymyalgia rheumatica (PMR) alongside a left breast mass.
- The patient's age, modest inflammatory markers, and incomplete response to corticosteroids were atypical for classic PMR.
- Diagnostic workup revealed infiltrating ductal carcinoma of the breast.
Findings:
- The breast cancer was identified as the underlying cause of the patient's PMR-like symptoms.
- Atypical features in PMR presentation warrant a thorough investigation for secondary causes.
- Early recognition of malignancy associated with PMR can improve patient outcomes.
Implications:
- Physicians should maintain a high index of suspicion for occult malignancy in patients with polymyalgia rheumatica (PMR), especially those with unusual clinical presentations.
- Atypical PMR symptoms, including younger age, mild inflammatory marker elevation, and poor corticosteroid response, necessitate a broader differential diagnosis.
- Integrating oncological screening into the diagnostic approach for atypical PMR can lead to earlier cancer detection and treatment.
