Giant Cell Arteritis Mimicking Polymyalgia Rheumatica: A Challenging Diagnosis

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This case report describes a rare case of intravascular large B-cell lymphoma (IVLBCL), initially presenting with nonspecific symptoms of fever and fatigue, and tentatively diagnosed as disseminated carcinomatosis of the bone marrow originating from urothelial cancer in an 80-year-old woman. The patient’s journey began with symptoms treated as common ailments and progressed through multiple differential diagnoses, including giant cell arteritis, TAFRO (thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly) syndrome, and disseminated carcinomatosis of the bone marrow originating from urothelial cancer due to the presence of systemic inflammation, anasarca, and elevated soluble interleukin 2 receptor levels, indicative of an intense immunological response. Despite initial treatments, her condition deteriorated, leading to further investigations that ultimately revealed the presence of malignant cells in the urine and bone marrow, confirming the diagnosis of IVLBCL. This case underscores the diagnostic challenges faced when elderly patients present with systemic inflammation and the critical need for thorough investigation beyond initial impressions. It highlights the importance of considering differentiation between disseminated carcinomatosis of the bone marrow and IVLBCL in the differential diagnosis of persistent inflammation, especially in cases where common causes have been excluded and the primary malignancy is not immediately apparent.

Section: Discussionmentioning

confidence: 99%

Differentiation Between Disseminated Carcinomatosis of the Bone Marrow From Urothelial Cancer and Intravascular Large B-cell Lymphoma: A Case Report

Ohta,

Nishikura,

Suyama

et al. 2024

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“…The coexistence of chronic bronchitis and GCA, or chronic bronchitis triggered by GCA, can be challenging to differentiate in clinical situations. To effectively manage such situations, assessing responses to treatments for both diseases is a reasonable strategy [ 9 ]. Considering the level of emergency, GCA should be initially treated with steroids and other immunosuppressants such as methotrexate and tocilizumab [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Giant Cell Arteritis With Chronic Bronchitis Successfully Treated With Tocilizumab

Ohta¹,

Nishikura²,

Ikeda³

et al. 2023

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Giant cell arteritis (GCA) causes systemic symptoms; however, involvement of the lungs is relatively rare compared to other rheumatic diseases such as rheumatoid arthritis and systemic sclerosis. Diagnosis and treatment of GCA complicated by chronic lung diseases can be challenging. In this case, an 87-year-old male presented with the chief complaints of systemic muscular pain and cough. The patient was eventually diagnosed with GCA complicated by chronic bronchitis. Although GCA treatment with chronic bronchitis is uncertain, we treated the patient with tapering doses of prednisolone and tocilizumab, which were effective. In older patients with systemic muscular pain and cough, GCA can be considered a differential diagnosis, and tocilizumab can be a reliable treatment in cases complicated by lung diseases, similar to other rheumatic diseases.

“…As a result, medical professionals deal with their symptoms in a mild and undeferential manner, with symptomatic treatment affected by ageism [ 16 , 17 ]. In particular, various symptoms often appear because of autoimmunity in older patients with autoimmune diseases such as RA [ 18 , 19 ]. Therefore, we strongly suggest considering various possibilities of RA when symptoms of older patients with RA worsen; to this end, health care professionals should take accurate clinical histories, perform precise physical examinations, and follow up with the patients closely.…”

Section: Discussionmentioning

confidence: 99%

Secondary Failure of Tocilizumab in Treating Elderly-Onset Rheumatoid Arthritis With Systemic Symptoms Complicated by Diverticulum Perforation

Takagi¹,

Naito²,

Sano³

et al. 2022

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The treatment of rheumatoid arthritis (RA) has advanced from the use of steroids to disease-modifying antirheumatic drugs (DMARDs) and biologics such as tumor necrosis factor (TNF) and interleukin-6 (IL-6) inhibitors. Historically, steroids have been the mainstream in the clinical treatment of RA; however, the development of DMARDs has changed the RA treatment structure. In addition, biologics can alleviate RA symptoms. This case report describes the secondary failure of tocilizumab in treating RA with fatigue symptoms. Treatment with tocilizumab decreases C-reactive protein (CRP) levels, which may make detecting RA exacerbation difficult; therefore, obtaining the patient's precise history and thorough physical examinations are necessary. This case demonstrates the complexity of treating elderly-onset RA and reports practical methods for effective treatment.