Polymyalgia rheumatica following robotic radical prostatectomy

Abstract

INTRODUCTIONPolymyalgia rheumatica (PMR) is an inflammatory syndrome of unknown etiology has also been associated with concurrent malignancy. Here we report PMR occurring de novo in a man following successful robotic radical prostatectomy. PRESENTATION OF CASEA 67-year-old gentleman underwent uneventful robotic assisted radical prostatectomy with complete excision of a T2C Gleason 7 tumour and a post-operative undetectable PSA. Three weeks after surgery he developed pain and weakness of the upper arms requiring increasing doses of opioids. Assessment identified a grossly elevated ESR and CRP consistent with a clinical diagnosis of PMR. Treatment with oral steroids led to a rapid resolution of symptoms. DISCUSSIONThere have been reported cases of polymyalgia rheumatica occurring following surgical procedures but not with robotic prostate surgery. It has been proposed that surgical tissue injury can cause a release of inflammatory markers. Surgical stress-related sympathetic activation can also stimulate lymphocyte dependent inflammatory reactions by modulation of cytokine production and lymphocyte expressed adrenergic receptors. CONCLUSIONWe present here the first reported case of PMR developing acutely after radical robotic prostatectomy. It is possible that the surgical procedure in this case had triggered polymyalgia rheumatica possibly through activation of immune-mediated systemic inflammatory responses.