Report of anti-CCP antibody positive paraneoplastic polyarthritis and review of the literature |
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Authors: | Emily Larson Delene Etwaru Chokkalingam Siva Kenneth Lawlor |
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Institution: | (1) Division of Rheumatology, Department of Internal Medicine, University of Missouri School of Medicine, CE 326, DC 043.00, 5 Hospital Drive, Columbia, MO 65212, USA;(2) 1 Hospital Dr., Columbia, MO 65212, USA |
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Abstract: | A 45-year-old female presented to the rheumatology clinic with complaint of pain and swelling of multiple small joints of
the hands and feet. She also complained of cough and shortness of breath onset around the same time. Since her cyclic citrullinated
peptide antibody (anti-CCP) and rheumatoid factor tests were positive, rheumatoid arthritis (RA) was diagnosed and she was
started on prednisone with plans for additional disease modifying therapy. Chest X-ray showed a small right pleural effusion.
While additional pulmonary evaluation was being planned, a few weeks later she presented with dyspnea, fever and tachycardia.
Spiral CT showed pulmonary emboli and increased pleural effusion and patient was started on anticoagulation. A chest tube
was placed and exudative pleural effusion was drained. Cytology sample from bronchoscopy raised concerns for adenocarcinoma.
Open lung biopsy confirmed moderately differentiated adenocarcinoma. The patient died of lung cancer in the hospital 8 weeks
from her diagnosis of RA. We describe a case of paraneoplastic polyarthritis with positive anti-CCP antibody test which has
not been reported before. We also review the literature on paraneoplastic arthritis which has been described in association
with various other malignancies besides lung cancer. |
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