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Polymyalgia Rheumatica or Something Else? Bilateral Shoulder, Arm, and Thigh Pain with Diffuse Marrow Edema Revealing
Kazuya Matsumoto1, Yoshinori Matsumoto1, Shoichi Nawachi1
1Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
Internal Medicine (Tokyo, Japan)
|August 10, 2026
Summary
B-cell acute lymphoblastic leukemia (B-ALL) can mimic polymyalgia rheumatica in adults, causing diagnostic delays. Early bone marrow examination prompted by MRI findings is crucial for timely leukemia diagnosis and treatment.
Area of Science:
- Hematology
- Oncology
- Rheumatology
Background:
- B-cell acute lymphoblastic leukemia (B-ALL) is a rare adult malignancy.
- Polymyalgia rheumatica-like syndromes can present atypically, leading to diagnostic delays.
- Magnetic resonance imaging (MRI) may show nonspecific bone marrow abnormalities.
Purpose of the Study:
- To highlight B-ALL presenting as polymyalgia rheumatica-like symptoms in an adult.
- To emphasize the role of MRI in detecting bone marrow infiltration.
- To advocate for early bone marrow examination in suspected atypical polymyalgia rheumatica.
Main Methods:
- Case report of a Japanese woman in her 40s with bilateral limb pain.
- Initial assessment included laboratory tests and MRI.
- Diagnosis confirmed by bone marrow biopsy and subsequent chemotherapy.
Main Results:
- Patient presented with anemia and elevated CRP, mimicking polymyalgia rheumatica.
- MRI showed diffuse bone marrow and muscle abnormalities.
- Bone marrow biopsy revealed CD19-positive lymphoblasts, confirming B-ALL.
- Chemotherapy led to rapid pain relief and clinical normalization.
Conclusions:
- B-ALL can manifest with polymyalgia rheumatica-like symptoms in adults.
- MRI findings suggestive of bone marrow infiltration warrant further investigation.
- Prompt diagnosis and avoidance of premature steroid treatment are vital for life-threatening conditions like leukemia.
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