Seronegative enthesoarthritis as the first presentation of the atrial myxoma

Abstract

Atrial myxoma (AM) is the most common primary cardiac tumor. Its clinical presentation can be highly heterogeneous and can be characterized by many constitutional manifestations and development of rheumatologic symptoms.We report the case of a patient presenting with a seronegative arthritis characterized by articular and enthesis involvement and purpuric cutaneous lesions that was refractory to conventional treatments and that was later diag- nosed with an AM as first cause of the manifestations. AM can present with different symptoms; among them, it is able to cause some rheumatological manifestation as it is able to secrete proinflammatory cytokines, as interleukin 6 (IL-6), tumor necrosis factor α (TNF-α), and interferon γ (IFN-γ). The present case is of particular interest as it presents an AM as the cause of an inflammatory arthropathy with articular and enthesis involvement. A paraneoplastic screening is always relevant in rheumatology, especially when encountering a refractory disease.

Keywords: arthritis; atrial myxoma; paraneoplastic syndromes; vasculitis.

Figure 1

Purpuric lesions on the plantar side of the right foot (left). Echographic image of plantar fascia edema of the left foot (transverse section) (right).

Figure 2

Echocardiographic image of the AM occupying almost all the left atrium and mitral valve. AM, atrial myxoma.