[Therapy refractory atypical polyarthritis and cryoglobulinemia in a patient with colon carcinoma and palliative intestinal bypass. Differential diagnosis: carcinoma-polyarthritis or bypass arthritis].
The case of a 63 year old woman with mesenteric recurrence of a colonic carcinoma and infiltration of the duodenum is reported. To bypass duodenal stenosis a duodenojejunostomy was performed. Three months later the patient developed severe atypical polyarthritis which led to hospitalization. The arthritis affected large and small joints in an asymmetrical pattern. Fever and Raynaud's phenomenon of both hands accompanied the arthritis. Elevated sedimentation rate, acute phase proteins, cryoglobulinemia and immune complexes were remarkable laboratory findings. Rheumatoid factor was absent. In the subsequent course the polyarthritis was refractory to steroids and nonsteroidal anti-inflammatory drugs. Only treatment with broad-spectrum antibiotics ameliorated the arthritis. Postenteric reactive arthritis, septic arthritis and metastatic arthritis could be excluded. Although the patient had a family history of rheumatoid arthritis and a HLA-type DR4 the diagnosis of rheumatoid arthritis was not very likely since distal interphalangeal joints were affected, rheumatoid factor was absent and antibiotic therapy was successful. The case serves to discuss carcinoma-polyarthritis and bypass-arthritis as the main differential diagnosis.
D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery; D016918:Arthritis, Reactive / Q000175:diagnosis / Q000628:therapy; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000628:therapy; D003110:Colonic Neoplasms / Q000601:surgery*; D003449:Cryoglobulinemia / Q000175:diagnosis* / Q000628:therapy; D003937:Diagnosis, Differential; D004379:Duodenal Neoplasms / Q000556:secondary* / Q000601:surgery; D004380:Duodenal Obstruction / Q000601:surgery*; D005260:Female; D006801:Humans; D007582:Jejunostomy; D008875:Middle Aged; D010166:Palliative Care; D010257:Paraneoplastic Syndromes / Q000175:diagnosis* / Q000628:therapy; D011183:Postoperative Complications / Q000175:diagnosis* / Q000628:therapy
Therapierefraktäre atypische Polyarthritis und Kryoglobulinämie bei einer Patientin mit Kolonkarzinom und palliativem intestinalen Bypass. DD: Karzinom-Polyarthritis oder Bypass-Arthritis.