A case of treatment-refractory paraneoplastic polymyalgia rheumatica that improved after tumor resection

Polymyalgia rheumatica and papillary thyroid carcinoma

Authors

DOI:

https://doi.org/10.17161/rrnmf.v5i3.21364

Keywords:

Polymyalgia Rheumatica, Papillary thyroid carcinoma, paraneoplastic syndrome, proximal weakness, myalgias, case report

Abstract

We present a case of a 53-year-old man whose clinical history, examination, and laboratory markers were deemed consistent with the diagnosis of polymyalgia rheumatica (PMR). These symptoms were initially relieved by oral steroids but unexpectedly returned with repeated attempts to taper the steroid dose slowly over time. Among his extensive evaluations for these symptoms, an MRI of the cervical spine was performed and demonstrated an ‘incidental’ thyroid mass. This was eventually diagnosed as papillary thyroid carcinoma and a total thyroidectomy was performed 6 months after his PMR symptom onset. The patient’s refractory PMR symptoms resolved shortly thereafter, and he was successfully weaned from oral steroids.  This remission following tumor resection posed an interesting question of a paraneoplastic process, which will be explored here.

Metrics

File downloads
31

Downloads

References

Kermani TA, Warrington KJ. Polymyalgia rheumatica. Lancet. 2013 Jan 5;381(9860):63-72. doi: 10.1016/S0140-6736(12)60680-1. Epub 2012 Oct 8. Erratum in: Lancet. 2013 Jan 5;381(9860):28. PMID: 23051717.

Keith MP, Gilliland WR. Polymyalgia rheumatica and breast cancer. J Clin Rheumatol. 2006 Aug;12(4):199-200. doi: 10.1097/01.rhu.0000231359.41352.c0. PMID: 16891926.

Muller S, Hider S, Helliwell T, Partington R, Mallen C. The real evidence for polymyalgia rheumatica as a paraneoplastic syndrome. Reumatismo. 2018 Mar 27;70(1):23-34. doi: 10.4081/reumatismo.2018.1031. PMID: 29589400.

Naschitz JE. Rheumatic syndromes: clues to occult neoplasia. Curr Opin Rheumatol. 2001 Jan;13(1):62-6. doi: 10.1097/00002281-200101000-00010. PMID: 11148717.

Egiziano G, Bernatsky S, Shah AA. Cancer and autoimmunity: Harnessing longitudinal cohorts to probe the link. Best Pract Res Clin Rheumatol. 2016 Feb;30(1):53-62. doi: 10.1016/j.berh.2016.03.001. Epub 2016 Apr 9. PMID: 27421216; PMCID: PMC4947510.

Bellan M, Boggio E, Sola D, Gibbin A, Gualerzi A, Favretto S, Guaschino G, Bonometti R, Pedrazzoli R, Pirisi M, Sainaghi PP. Association between rheumatic diseases and cancer: results from a clinical practice cohort study. Intern Emerg Med. 2017 Aug;12(5):621-627. doi: 10.1007/s11739-017-1626-8. Epub 2017 Feb 8. PMID: 28181122.

Kehler T, Curković B. Polymyalgia rheumatica and colon malignacy: case report. Clin Rheumatol. 2006 Sep;25(5):764-5. doi: 10.1007/s10067-005-0069-1. Epub 2005 Oct 25. PMID: 16249824.

Tabata M, Kobayashi T. Polymyalgia rheumatica and thyroid papillary carcinoma. Intern Med. 1994 Jan;33(1):41-4. doi: 10.2169/internalmedicine.33.41. PMID: 8180442.

Uchida T, Matsubara H, Ohnuki Y, Sugimura A, Matsuoka H, Ichihara T, Nakajima H. Ciliated muconodular papillary tumor of the lung presenting with polymyalgia rheumatica-like symptoms: a case report. AME Case Rep. 2019 Oct 11;3:37. doi: 10.21037/acr.2019.09.06. PMID: 31728435; PMCID: PMC6851452.

Weyand CM, Hunder NN, Hicok KC, Hunder GG, Goronzy JJ. HLA-DRB1 alleles in polymyalgia rheumatica, giant cell arteritis, and rheumatoid arthritis. Arthritis Rheum. 1994 Apr; 37(4):514-20.

Downloads

Published

2024-12-17

Issue

Section

Clinic and Case Reports

How to Cite

Grant, L., Kim, A., Beeler, M., & Bresner, J. (2024). A case of treatment-refractory paraneoplastic polymyalgia rheumatica that improved after tumor resection: Polymyalgia rheumatica and papillary thyroid carcinoma. RRNMF Neuromuscular Journal, 5(3). https://doi.org/10.17161/rrnmf.v5i3.21364