Synovitis in angioimmunoblastic lymphadenopathy with dysproteinemia simulating rheumatoid arthritis.
We describe a patient with angioimmunoblastic lymphadenopathy with dysproteinemia who developed a symmetric, rheumatoid-like, peripheral polyarthritis. Radiographs of the involved joints revealed soft tissue swelling without erosions or cartilage loss. Rheumatoid factor and fluorescent antinuclear antibodies were negative, and C-reactive protein and erythrocyte sedimentation rate were normal. Synovial fluid analysis showed an inflammatory effusion (white blood cell count of 3,500/mm3, with 76% polymorphonuclear leukocytes). A closed synovial biopsy of the wrist revealed a mononuclear infiltrate consistent with angioimmunoblastic lymphadenopathy with dysproteinemia. Monthly parenteral chemotherapy treatment with high-dose methyl-prednisolone and cyclophosphamide resulted in remission of all manifestations of disease, including arthritis.
Boumpas
D T
DT
Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892.
Wheby
M S
MS
Jaffe
E S
ES
Steinberg
A D
AD
Klippel
J H
JH
Balow
J E
JE
D001172:Arthritis, Rheumatoid / Q000175:diagnosis*; D002648:Child; D003937:Diagnosis, Differential; D006801:Humans; D006942:Hypergammaglobulinemia / Q000150:complications*; D007119:Immunoblastic Lymphadenopathy / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D007074:Immunoglobulin G / Q000032:analysis; D007075:Immunoglobulin M / Q000032:analysis; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D012867:Skin / Q000473:pathology; D013583:Synovial Membrane / Q000473:pathology; D013585:Synovitis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology
D007074:Immunoglobulin G; D007075:Immunoglobulin M