title: Paraneoplastic syndrome, infection or arthritis: Difficulties in diagnosis.
abstract: Many different diseases have overlapping clinical symptoms. A major challenge in daily clinical practice is to differentiate between diseases associated with systemic inflammation, such as neoplasia, infection and autoimmune disease. We report on a 46-year-old Caucasian male with a 3-month history of rheumatoid arthritis presenting with dramatic weight loss and dysphagia. Computer tomography revealed multiple lesions in the liver and the spleen, strongly suggesting malignant disease of unknown origin. Surprisingly, on biopsy, the liver lesions drained pus. Workup revealed that the abscesses resulted from gastric perforation, which was the consequence of NSAR therapy for rheumatoid arthritis. Antibiotic therapy was initiated, abscesses diminished and dysfunctional deglutition improved. This unique case demonstrates in a dramatic way the difficulties in daily clinical practice to differentiate between paraneoplasia, infection and autoimmune disease and the potentially life-threatening consequences of their therapy.
authors.affiliation: Department of Internal Medicine, University of Erlangen-Nuremberg, Erlangen, Germany. axel.hueber@med3.imed.uni-erlangen.de
authors.forename: A J
authors.initials: AJ
authors.lastname: Hueber
authors.forename: J
authors.initials: J
authors.lastname: Rech
authors.forename: S
authors.initials: S
authors.lastname: Kallert
authors.forename: C
authors.initials: C
authors.lastname: Requadt
authors.forename: A
authors.initials: A
authors.lastname: Cavallaro
authors.forename: J R
authors.initials: JR
authors.lastname: Kalden
authors.forename: H
authors.initials: H
authors.lastname: Schulze-Koops
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy; D003680:Deglutition Disorders / Q000382:microbiology; D003937:Diagnosis, Differential; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D010257:Paraneoplastic Syndromes / Q000175:diagnosis*; D013158:Splenic Diseases / Q000175:diagnosis* / Q000382:microbiology; D013275:Stomach Rupture / Q000139:chemically induced; D013290:Streptococcal Infections / Q000175:diagnosis*; D034367:Streptococcus intermedius / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed; D015431:Weight Loss
chemical_list: D018501:Antirheumatic Agents