Arthritis as an initial presentation of malignancy: two case reports

Benjamin Sachdev Manjit Singh,Cheng Lay Teh,Seow Lin Chuah,Ahmad Tirmizi Jobli,Yaw Kiet Cheong,Sharifah Aishah Wan

doi:10.1186/s13256-020-02642-z

Benjamin Sachdev Manjit Singh, Cheng Lay Teh + Show 4 more

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https://doi.org/10.1186/s13256-020-02642-z

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Abstract

BackgroundArthritis is rarely reported as a paraneoplastic manifestation of occult malignancy. We report herein two cases of paraneoplastic arthritis due to occult malignancy.Case 1The patient was a 65-year-old woman of asian descent who was a former smoker with a history of spine surgery performed for L4/L5 degenerative disc disease. She presented with a 1-month history of oligoarthritis affecting both ankle joints and early morning stiffness of about 3 hours. Laboratory tests were positive for antinuclear antibody at a titer of 1:320 (speckled) but negative for rheumatoid factor. She was treated for seronegative spondyloarthritis and started on prednisolone without much improvement. A routine chest radiograph incidentally revealed a right lung mass which was found to be adenocarcinoma of the lung. She was treated with gefitinib and her arthritis resolved.Case 2The patient was a 64-year-old woman of asian descent, nonsmoker, who presented with a chief complaint of asymmetrical polyarthritis involving her right wrist, second and third metacarpophalangeal joints, and first to fifth proximal interphalangeal joints. She was treated for seronegative rheumatoid arthritis (RA) and started on sulfasalazine, with poor clinical response. Six months later, she developed abdominal pain which was diagnosed as ovarian carcinoma by laparotomy. Her arthritis resolved following treatment of her malignancy with chemotherapy.ConclusionIn summary, paraneoplastic arthritis usually presents in an atypical manner and responds poorly to disease-modifying antirheumatic drugs. Accordingly, we recommend screening for occult malignancy in patients presenting with atypical arthritis.

Highlights

Arthritis is rarely reported as a paraneoplastic manifestation of occult malignancy
In summary, paraneoplastic arthritis usually presents in an atypical manner and responds poorly to disease-modifying antirheumatic drugs
We recommend screening for occult malignancy in patients presenting with atypical arthritis

Summary

Background

Paraneoplastic syndromes are a collection of signs and symptoms caused by organ or tissue damage occurring at locations distant from primary tumors [1]. The mass was biopsied via bronchoscopy, and histopathological examination (HPE) results showed an adenocarcinoma favoring a primary lung malignancy, which showed a deletion in exon 19 of the epidermal growth factor receptor (EGFR) gene She was treated with tablet gefitinib 250 mg daily by the oncology team. Case 2 The patient was a 64-year-old woman of asian descent who was a nonsmoker, nondrinker and known to have hypertension, diabetes mellitus, dyslipidemia and ischemic heart disease She was a retiree and was previously on the following medications: metformin 500 mg once daily, amlodipine 10 mg daily, atenolol 100 mg daily, isosorbide dinitrate 10 mg three times a day, aspirin 75 mg once a day, simvastatin 10 mg once daily and perindopril 2 mg daily. A CT reassessment post-carboplatin/ paclitaxel showed disease progression, as evidenced by a larger left lung mass on CT She was given secondline chemotherapy consisting of gemcitabine 1400 mg intravenously on day 1 and day 8, planned for three cycles and reassessment of response.

Discussion

Conclusion