Polymyalgia rheumatica-like presentation in a case of diffuse large B-cell lymphoma: a diagnostic pitfall
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SAGE Publications Ltd
Abstract
Diffuse large B-cell lymphoma (DLBCL) commonly presents with systemic manifestations including fever, weight loss, and night sweats. Uncommonly, patients with DLBCL can present with musculoskeletal manifestations mimicking polymyalgia rheumatica (PMR). Herein, the case of a 61-year-old woman who presented with pain in the bilateral shoulders, arms, hands, knees, pelvic girdle, and neck with bouts of fever, is presented. Laboratory workup for infectious and connective tissue diseases was non-revealing, except for elevated inflammatory markers. A positron emission tomography (PET)/computed tomography (CT) scan was suggestive of PMR, but also revealed enlarged lymph nodes initially thought to be reactive in nature. However, a lymph node biopsy showed findings consistent with DLBCL. This case highlights the importance of a thorough investigational workup when cases with features of PMR do not meet the proper criteria for this diagnosis to be made, in order not to miss a hematopoietic neoplasm with a PMR-like presentation. © The Author(s) 2021.
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Enlarged lymph nodes, Hematopoietic neoplasm, Mimickers, Non-hodgkin lymphoma, Paraneoplastic conditions, Polymyalgia rheumatica, Biopsy, Female, Giant cell arteritis, Humans, Lymphoma, large b-cell, diffuse, Middle aged, Positron emission tomography computed tomography, Aceclofenac, C reactive protein, Cyclophosphamide, Dexamethasone, Diphenhydramine, Doxorubicin, Ferritin, Fluorodeoxyglucose f 18, Fosaprepitant, Methotrexate, Prednisolone, Rituximab, Vincristine, Adult, Article, Cancer chemotherapy, Case report, Clinical article, Clinical evaluation, Clinical feature, Computer assisted tomography, Diffuse large b cell lymphoma, Drug megadose, Erythrocyte sedimentation rate, Experience, Ferritin blood level, Fever, Human, Human tissue, Image analysis, Immunohistochemistry, Lymph node biopsy, Lymphadenopathy, Medical history, Morning stiffness, Multiple cycle treatment, Muscle weakness, Musculoskeletal pain, Physical examination, Positron emission tomography-computed tomography, Protein blood level, Remission, Rheumatic polymyalgia, Symptom, Thorax radiography, Treatment duration, Treatment response, Diagnostic imaging