Articular, B-cell, non-Hodgkin's lymphoma mimicking rheumatoid arthritis: synovial involvement in a small hand joint
Articular, B-cell, non-Hodgkin's lymphoma mimicking rheumatoid arthritis: synovial involvement in a small hand joint
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DOI：
10.1007/s00296-003-0373-5
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发表时间：
2004-05-01
影响因子：
4
通讯作者：
Akkoc, N
中科院分区：
文献类型：
--
作者：
Birlik, M;Akar, S;Akkoc, N
摘要以多关节表现为主要症状的非何杰金氏淋巴瘤相当罕见。在没有周围淋巴结和内脏受累的情况下，淋巴瘤表现为多发性关节炎，给患者带来另一种风湿性疾病的问题。我们提出一个案例，已被诊断为类风湿性关节炎，因为对称的关节症状。患者随后出现严重疼痛，右手无名指明显肿胀，诊断为脓毒性关节炎和骨髓炎并发类风湿性关节炎。只有在对从截肢手指获得的活检标本进行组织病理学检查后，才能最终诊断为伴有滑膜受累的NHL。这是第一个病例报告表明，直接滑膜参与的一个小关节的患者与非霍奇金淋巴瘤提出多关节炎。MRI显示多个关节的关节和关节周围受累提示滑膜直接受累可能是导致多关节症状的原因。
Polyarticular joint manifestations as the predominant symptom of non-Hodgkin's lymphoma (NHL) are quite rare. In the absence of peripheral lymph node and visceral involvement, lymphomas presenting as polyarthritis create a problem for the patients as another rheumatic disease. We present a case that had been diagnosed with rheumatoid arthritis because of symmetrical articular symptoms. The patient later developed severe pain and marked swelling in her right fourth finger, and a diagnosis of septic arthritis and osteomyelitis complicating rheumatoid arthritis was assumed. The final diagnosis of NHL with synovial involvement could be made only after histopathologic examination of a biopsy specimen obtained from the amputated finger. This is the first case report demonstrating direct synovial involvement of a small joint in a patient with NHL presenting with polyarthritis. Articular and periarticular involvement of multiple joints shown by MRI in this patient suggests that direct synovial involvement may be responsible for the polyarticular symptoms in such patients.