Positron emission tomography findings in a patient with multiple myeloma of polymyalgia rheumatica-like symptoms caused by paraneoplastic syndrome.
A 50-year-old Japanese man was referred to our department with pain in his limb joints persisting for 3 months. Although his joints showed no redness, swelling or tenderness, he had a limited range of motion of his hip and shoulder joints, suggesting a diagnosis of polymyalgia rheumatica (PMR). However, his relatively young age and subacute course along with the absence of morning stiffness made the diagnosis uncertain. We performed positron emission tomography/CT, which revealed 18F-fluorodeoxyglucose uptake in bilateral upper and lower joints, consistent with PMR. There was also uptake by a sacral tumour, suggesting a diagnosis of paraneoplastic syndrome. Immunoglobulin A-κ type M protein was detected in serum and bone marrow aspiration/biopsy identified diffuse proliferation of atypical plasma cells, confirming a diagnosis of multiple myeloma. The patient received chemotherapy, which alleviated his limb pain, and achieved stringent complete remission after autologous peripheral blood stem cell transplantation.
Department of General Medicine, Chiba University Hospital, Chiba, Japan.
Shingo
S
Suzuki
Masatomi
M
Ikusaka
Masahito
M
Miyahara
Kiyoshi
K
Shikino
D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000473:pathology; D059352:Musculoskeletal Pain / Q000175:diagnosis* / Q000209:etiology; D010257:Paraneoplastic Syndromes / Q000175:diagnosis* / Q000473:pathology; D011111:Polymyalgia Rheumatica / Q000175:diagnosis*; D049268:Positron-Emission Tomography; D033581:Stem Cell Transplantation