Polymyalgia rheumatica (PMR) is one of the most common inflammatory disorders in elderly population [
A 84-year-old man, with a history of idiopathic neutropenia, presents with an inflammatory arthromyalgia of the limb girdle for one month. He described a morning stiffness over an hour and an improvement of the symptoms during the day. There were neither synovitis nor arguments for giant cell arteritis. The X-ray imaging was normal and the blood exams highlighted an inflammatory syndrome (CRP: 53 mg/l), a neutropenia (1200 G/mm3), no autoantibodies, and the presence of a monoclonal B cell clone. Bone marrow aspiration revealed lymphocytic infiltration lower than 1% and concluded to a B cell lymphoma of the marginal zone. The thoracoabdominal CT scan showed multiple mediastinal and cervical lymphadenopathies. No treatment was necessary for the lymphoma and the hematologists gave their agreement for a treatment with prednisone for the management of the PMR. Symptoms were controlled after 3 days of treatment with 0.3 mg/kg/d of prednisone with a sustained response after 12 months of treatment with decreasing dose of prednisone.
A 73-year-old man, with a history of prostatic neoplasia treated by prostatectomy and in remission for 5 years, presented with arthromyalgia of the limb girdle for one month. The blood examinations revealed an inflammatory syndrome (CRP 63 mg/l), undetectable PSA, and no autoantibodies (rheumatoid factor and antinuclear and anti-CCP negative). Finally, a PET-CT revealed a metabolically active iliac lymphadenopathy, no prostatic cancer recurrence, and bursitis of the hips and the shoulders (Figure
PET-CT pictures of symmetrical shoulders hypermetabolic bursitis (a) and of metabolic active iliac lymphadenopathy (b).
These cases suggest a possible link between PMR and lymphoma. This association has been described in the initial stage of the symptoms and only three other cases are described in the PubMed database [
In the second case, the PET-CT demonstrated two advantages. First, it enabled the positive diagnosis of PMR and highlighted metabolic active lymphadenopathies. One other case of concomitant lymphoma to PMR was diagnosed using PET-CT. There is currently a growing interest for this imaging procedure [
In the future, it would be interesting to know if, with the contribution of PET-CT, the prevalence of PMR presenting as a paraneoplastic syndrome will increase and if the prevalence of lymphoma associated with PMR will increase.
The authors declare that they have no competing interests.