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Case Reports
. 2021 Feb 23;15(1):94.
doi: 10.1186/s13256-020-02642-z.

Arthritis as an initial presentation of malignancy: two case reports

Benjamin Sachdev Manjit Singh  1 , Sharifah Aishah Wan  1 , Yaw Kiet Cheong  1 , Seow Lin Chuah  1 , Cheng Lay Teh  1 , Ahmad Tirmizi Jobli  2
Affiliations
Case Reports

Arthritis as an initial presentation of malignancy: two case reports

Benjamin Sachdev Manjit Singh et al. J Med Case Rep. .

Abstract

Background: Arthritis is rarely reported as a paraneoplastic manifestation of occult malignancy. We report herein two cases of paraneoplastic arthritis due to occult malignancy. CASE 1: The 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 2: The 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.

Conclusion: In 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.

Keywords: Arthritis; Malignancy; Paraneoplastic.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Chest X-ray (posteroanterior erect view) with mass over the right lower lobe
Fig. 2
Fig. 2
Sagittal computed tomography scan of the thorax demonstrates mass at the right lower lobe with associated surrounding satellite nodules (arrows)
Fig. 3
Fig. 3
Coronal computed tomography scan image demonstrating uterine mass infiltrating the adjacent bowels and omentum (blue arrows)
Fig. 4
Fig. 4
Sagittal computed tomography scan image demonstrating uterine fundus mass which has poor demarcation with the uterus inferiorly (arrow)
See this image and copyright information in PMC

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