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Polymyalgia rheumatica in a patient with splenic marginal zone lymphoma - a case report
Bartłomiej Kisiel1, Krzysztof Gawroński2, Piotr Rzepecki2
1Military Institute of Medicine, Warszawa, Poland: Department of Internal Diseases and Rheumatology.
Abstract:
Polymyalgia rheumatica (PMR) is a common inflammatory disease in elderly people. We present a case of a 49-year-old woman diagnosed with PMR. The treatment with prednisone resulted in a rapid resolution of clinical symptoms. However, inflammatory markers remained elevated. Ultrasonography and computed tomography revealed the presence of a large splenic lesion. A cyst was suspected but, because of the high risk of splenic rupture, a splenectomy was performed. The histopathological examination revealed the presence of splenic marginal zone lymphoma. Inflammatory markers returned to normal after splenectomy. Prednisone was tapered but clinical symptoms of PMR reappeared after lowering the dose of prednisone <10 mg/day. Thus, treatment with methotrexate was started, which allowed for further tapering of prednisone.
Insights
Polymyalgia rheumatica can mimic other conditions. This case highlights splenic marginal zone lymphoma presenting as PMR, requiring splenectomy and further treatment.
Area of Science:
- Rheumatology
- Hematology
- Oncology
Background:
- Polymyalgia rheumatica (PMR) is a common inflammatory condition primarily affecting individuals over 50.
- Diagnosis of PMR typically relies on clinical symptoms and elevated inflammatory markers.
Observation:
- A 49-year-old woman presented with symptoms consistent with PMR.
- Initial prednisone treatment resolved clinical symptoms, but inflammatory markers remained high.
- Imaging revealed a large splenic lesion, prompting a splenectomy due to rupture risk.
Findings:
- Histopathology confirmed splenic marginal zone lymphoma, not a simple cyst.
- Splenectomy normalized inflammatory markers.
- PMR symptoms recurred upon prednisone dose reduction, necessitating methotrexate addition.
Implications:
- This case underscores the importance of considering hematological malignancies in atypical or persistent inflammatory presentations.
- Splenic marginal zone lymphoma can masquerade as polymyalgia rheumatica.
- Multidisciplinary management is crucial for complex cases involving both rheumatological and oncological conditions.
