[A case of malignant rheumatoid arthritis associated with myelodysplastic syndrome]

The patient (57 year-old female) complained of high fever and polyarthralgia in autumn of 1994, when a diagnosis of refractory anemia, a type of myelodysplastic syndrome (MDS) was made by severe anemia (RBC: 154 x 10(4)/microliters), leucopenia (2,200/microliters) and erythroid hyperplasia, ring-nucleated myelocyte, micromegakaryocyte and less than 5% of blasts in bone marrow smear. In her further clinical course, symptoms such as episcleritis, mononeuritis multiplex, skin ulcers on bilateral lower legs and circulating disturbance on left lower leg with high titer of rheumatoid factor were appeared in six months, suggesting malignant rheumatoid arthritis (MRA). She also had rectal cancer notified by anal bleeding. In spite of the administration of large doses of glucocorticoid and disease modifying anti-rheumatic drugs, circulating disturbance on left lower leg which might be caused by vasculitis was worsened to show tissue necrosis. Finally, she died of disseminated intravascular coagulation. The association of MDS with rheumatic disorders such as rheumatoid arthritis, Behçet disease and Sjögren's syndrome is not rarely reported. However, this is the first case of MDS associated with MRA.