Thymoma-Related Paraneoplastic Syndrome Mimicking Reactive Arthritis
<i>Background and Objectives</i>: Thymomas are associated with a high frequency of paraneoplastic manifestations. Paraneoplastic syndrome (PNS) with thymoma presents a challenge to clinicians because of the need to decipher the association between the presenting symptoms and the underlyi...
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doaj-60b6af8a93514b9ba77110d452f9abec2021-09-26T00:39:30ZengMDPI AGMedicina1010-660X1648-91442021-09-015793293210.3390/medicina57090932Thymoma-Related Paraneoplastic Syndrome Mimicking Reactive ArthritisChang-Hung Liao0Sin-Yi Lyu1Hsiang-Cheng Chen2Deh-Ming Chang3Chun-Chi Lu4Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, TaiwanDivision of Radiology, Tri-Service General Hospital Keelung Branch, National Defense Medical Center, Taipei 114, TaiwanDivision of Rheumatology/Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, TaiwanDivision of Rheumatology/Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, TaiwanDivision of Rheumatology/Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan<i>Background and Objectives</i>: Thymomas are associated with a high frequency of paraneoplastic manifestations. Paraneoplastic syndrome (PNS) with thymoma presents a challenge to clinicians because of the need to decipher the association between the presenting symptoms and the underlying tumor. The condition most commonly noted in patients with PNS with thymoma is myasthenia gravis. Other common autoimmune diseases that may present as PNS include systemic lupus erythematosus, pure red cell aplasia, and Good syndrome. Seventy-six percent of patients with PNS-associated thymoma experience resolution of PNS after curing thymoma. <i>Materials and Methods</i>: A 37-year-old man with a two-month fever accompanied by polyarthritis accidently found thymoma after contrast computed tomography scans of his chest. He accepted Video assisted thoracoscopic surgery with resection of thymoma. <i>Results</i>: Fever and polyarthritis resolved after operation but recurred in five days due to cytomegalovirus viremia, which might be predisposed by previous antibiotics treatment before the diagnosis of thymoma. <i>Conclusion</i>: Patients with a thymoma also have a high frequency of PNS, and the most frequent condition found in patients with PNS-associated thymoma is myasthenia gravis. Fever with polyarthritis has been rarely reported as a symptom of PNS-associated thymoma. Here we reported an unusual case of PNS mimicking reactive arthritis with thymoma, as diagnosed based on the patient’s clinical progression, imaging examination, and laboratory tests. The patient died of his comorbidities, and his death may have been related to long-term antibiotic use and consequent intestinal dysbiosis. This challenging case may help to inform clinicians of the need for detailed work-up of fever with unknown origin in the presence of chronic polyarthritis to prevent the overdiagnosis of inflammatory arthritis or rheumatic disease and avoid further comorbidities. Detailed work-up should include the patient’s history of infections, inflammation, and malignant or nonmalignant tumors.https://www.mdpi.com/1648-9144/57/9/932thymomaparaneoplastic syndromereactive arthritis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Chang-Hung Liao Sin-Yi Lyu Hsiang-Cheng Chen Deh-Ming Chang Chun-Chi Lu |
spellingShingle |
Chang-Hung Liao Sin-Yi Lyu Hsiang-Cheng Chen Deh-Ming Chang Chun-Chi Lu Thymoma-Related Paraneoplastic Syndrome Mimicking Reactive Arthritis Medicina thymoma paraneoplastic syndrome reactive arthritis |
author_facet |
Chang-Hung Liao Sin-Yi Lyu Hsiang-Cheng Chen Deh-Ming Chang Chun-Chi Lu |
author_sort |
Chang-Hung Liao |
title |
Thymoma-Related Paraneoplastic Syndrome Mimicking Reactive Arthritis |
title_short |
Thymoma-Related Paraneoplastic Syndrome Mimicking Reactive Arthritis |
title_full |
Thymoma-Related Paraneoplastic Syndrome Mimicking Reactive Arthritis |
title_fullStr |
Thymoma-Related Paraneoplastic Syndrome Mimicking Reactive Arthritis |
title_full_unstemmed |
Thymoma-Related Paraneoplastic Syndrome Mimicking Reactive Arthritis |
title_sort |
thymoma-related paraneoplastic syndrome mimicking reactive arthritis |
publisher |
MDPI AG |
series |
Medicina |
issn |
1010-660X 1648-9144 |
publishDate |
2021-09-01 |
description |
<i>Background and Objectives</i>: Thymomas are associated with a high frequency of paraneoplastic manifestations. Paraneoplastic syndrome (PNS) with thymoma presents a challenge to clinicians because of the need to decipher the association between the presenting symptoms and the underlying tumor. The condition most commonly noted in patients with PNS with thymoma is myasthenia gravis. Other common autoimmune diseases that may present as PNS include systemic lupus erythematosus, pure red cell aplasia, and Good syndrome. Seventy-six percent of patients with PNS-associated thymoma experience resolution of PNS after curing thymoma. <i>Materials and Methods</i>: A 37-year-old man with a two-month fever accompanied by polyarthritis accidently found thymoma after contrast computed tomography scans of his chest. He accepted Video assisted thoracoscopic surgery with resection of thymoma. <i>Results</i>: Fever and polyarthritis resolved after operation but recurred in five days due to cytomegalovirus viremia, which might be predisposed by previous antibiotics treatment before the diagnosis of thymoma. <i>Conclusion</i>: Patients with a thymoma also have a high frequency of PNS, and the most frequent condition found in patients with PNS-associated thymoma is myasthenia gravis. Fever with polyarthritis has been rarely reported as a symptom of PNS-associated thymoma. Here we reported an unusual case of PNS mimicking reactive arthritis with thymoma, as diagnosed based on the patient’s clinical progression, imaging examination, and laboratory tests. The patient died of his comorbidities, and his death may have been related to long-term antibiotic use and consequent intestinal dysbiosis. This challenging case may help to inform clinicians of the need for detailed work-up of fever with unknown origin in the presence of chronic polyarthritis to prevent the overdiagnosis of inflammatory arthritis or rheumatic disease and avoid further comorbidities. Detailed work-up should include the patient’s history of infections, inflammation, and malignant or nonmalignant tumors. |
topic |
thymoma paraneoplastic syndrome reactive arthritis |
url |
https://www.mdpi.com/1648-9144/57/9/932 |
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