Diffuse large B-cell lymphoma involving the left sternoclavicular joint mimicking rheumatoid arthritis flare: a case-based review.
Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting primarily joints and an increased risk of developing malignant lymphomas in RA has been well reported. However, primary lymphoma in a joint in RA patient is rare. We report the case of a 65-year-old man with RA suffering from pain and swelling of left sternoclavicular (SC) joint, which was not relieved by adding low-dose glucocorticoid. Magnetic resonance imaging (MRI) showed a para-osseous soft tissue swelling around the SC joint and a fracture of proximal clavicle. Histology of the soft tissue demonstrated diffuse large B-cell lymphoma and the patient subsequently underwent R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy. He was successfully treated with six cycles of R-CHOP chemotherapy, with discontinuation of MTX, resulting in a complete response. We performed a literature review and identified nine cases of lymphoma which involved joints in patients with rheumatoid arthritis. This is the first described case of a primary large B-cell lymphoma involving the unilateral SC joint in a patient with RA, which was initially confused with aggravation of RA. Therefore, malignant lymphoma should be considered in the differential diagnosis when a RA patient develops monoarthritis with spontaneous fracture, even without B symptoms.
['Chung|Sang Wan|SW|http://orcid.org/0000-0002-3449-696X', 'Park|Eun Hye|EH|http://orcid.org/0000-0002-6813-4182', 'Kang|Eun Ha|EH|http://orcid.org/0000-0001-9697-1159', 'Lee|Yun Jong|YJ|http://orcid.org/0000-0001-7615-8611', 'Ha|You-Jung|YJ|http://orcid.org/0000-0001-6107-9523']
D000368:Aged D000971:Antineoplastic Combined Chemotherapy Protocols D001172:Arthritis, Rheumatoid D003520:Cyclophosphamide D003937:Diagnosis, Differential D004317:Doxorubicin D005260:Female D006801:Humans D016403:Lymphoma, Large B-Cell, Diffuse D008297:Male D008875:Middle Aged D011241:Prednisone D000069283:Rituximab D013247:Sternoclavicular Joint D014750:Vincristine
Diffuse large B-cell lymphoma Sternoclavicular joint Rheumatoid arthritis Differential diagnosis