Journal List > J Rheum Dis > v.18(1) > 1063936

Kim, Choi, Lee, Lee, Lee, Seo, Kim, Park, and Lee: A Case of Paraneoplastic Syndrome Associated with Pancreatic Cancer Presenting as Rheumatoid Arthritis

Abstract

Paraneoplastic cancer polyarthritis is a very rare manifestation of musculoskeletal disorders associated with several solid and hematologic malignancies. We describe a 71-year- old woman who presented initially with an abrupt onset of rheumatoid arthritis-like symmetrical polyarthritis. The patient was diagnosed with pancreatic cancer with multiple hepatic metastases approximately six months later. Her symptoms of polyarthritis improved after the introduction of medication including nonsteroidal antiinflammatory drugs and disease modifying antirheumatic drugs. This case suggests that a hidden malignancy should always be considered in elderly patients, who present with an abrupt onset of symmetric polyarthritis for the first time in their life.

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Figure 1.
Tc-99m HDP scan showing increased uptake in multiple joints including both wrists, right 2 nd to 5 th metacarpophalangeal joints, right 3 rd to 4 th proximal interpha-langeal joints, left 2 nd to 3 rd metacarpophalangeal joints, right shoulder, and left 1 st to 3 rd metatarso-phalangeal joints. The scan also showed a fracture in the right femoral neck.
jrd-18-32f1.tif
Figure 2.
Contrast-enhanced abdominal computed tomography showing multiple liver metastases (arrows) by the pancreatic head malignancy (arrowheads) invading the adjacent gastric wall, distal common bile duct and vessels.
jrd-18-32f2.tif
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