Inflammatory Arthritis Preceded Leukemic Arthritis in a 60-Year-Old Female: A Case Report
Kamonwan Mulalin1, Chingching Foocharoen1, Theerin Lanamtieng2, Ajanee Mahakkanukrauh1
Affiliation : 1 Division of Rheumatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand 2 Division of Hematology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background: Leukemic arthritis is an uncommon presentation of acute and chronic leukemia which might cause by local reaction to bony, periosteal, or capsular infiltration by malignant cells. The patient may present with seronegative inflammatory arthritis, which precedes the diagnosis of leukemia and is usually resistant to corticosteroid treatment.
Case Report: The authors report a case of 60-year-old woman with leukemic arthritis, who was diagnosed with acute leukemia after the initial onset of arthritis. The patient had chronic arthritis in both knees and in her left ankle with unintentional weight loss over a 3-month period. The investigations revealed high C-reactive protein, and was negative for the rheumatoid factor, anti-cyclic citrullinated peptide, HLA-B27, anti-nuclear antibody, and anti-double stranded DNA. Synovial fluid analysis showed leukocytosis but was negative for both bacterial culture and polymerase chain reaction for tuberculosis. Even though the crystals were unable to be identified in the patient’s synovial fluid, the preliminary diagnosis for this patient was gouty arthritis. After systemic and intra-articular steroid injections, her symptoms did not improve even after treatment with allopurinol and colchicine. Her blood tests and a test of synovial fluid from her left knee revealed numerous blast cells. Bone scintigraphy revealed increasing radiotracer uptake around the left knee, which suggested inflammatory arthritis. Arthritis, which was mitigated by chemotherapy and a follow-up bone scintigraphy, showed decreasing radiotracer uptake compared to the previous examination. Conclusion: When treating patients with arthritis, it is important to consider a differential diagnosis of paraneoplastic arthritis or direct invasion by cancer.
Received 30 January 2024 | Revised 24 March 2024 | Accepted 15 April 2024
DOI: 10.35755/jmedassocthai.2024.S01.S142-S146
Keywords : Leukemic arthritis; Seronegative arthritis; Paraneoplastic arthritis; Carcinomatous arthritis; Acute myeloid leukemia
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