Synovitis in angioimmunoblastic lymphadenopathy with dysproteinemia simulating rheumatoid arthritis

Arthritis Rheum. 1990 Apr;33(4):578-82. doi: 10.1002/art.1780330417.

Abstract

We describe a patient with angioimmunoblastic lymphadenopathy with dysproteinemia who developed a symmetric, rheumatoid-like, peripheral polyarthritis. Radiographs of the involved joints revealed soft tissue swelling without erosions or cartilage loss. Rheumatoid factor and fluorescent antinuclear antibodies were negative, and C-reactive protein and erythrocyte sedimentation rate were normal. Synovial fluid analysis showed an inflammatory effusion (white blood cell count of 3,500/mm3, with 76% polymorphonuclear leukocytes). A closed synovial biopsy of the wrist revealed a mononuclear infiltrate consistent with angioimmunoblastic lymphadenopathy with dysproteinemia. Monthly parenteral chemotherapy treatment with high-dose methyl-prednisolone and cyclophosphamide resulted in remission of all manifestations of disease, including arthritis.

Publication types

  • Case Reports

MeSH terms

  • Arthritis, Rheumatoid / diagnosis*
  • Child
  • Diagnosis, Differential
  • Humans
  • Hypergammaglobulinemia / complications*
  • Immunoblastic Lymphadenopathy / complications
  • Immunoblastic Lymphadenopathy / diagnosis*
  • Immunoblastic Lymphadenopathy / drug therapy
  • Immunoblastic Lymphadenopathy / pathology
  • Immunoglobulin G / analysis
  • Immunoglobulin M / analysis
  • Lymph Nodes / pathology
  • Middle Aged
  • Skin / pathology
  • Synovial Membrane / pathology
  • Synovitis / complications
  • Synovitis / diagnosis*
  • Synovitis / pathology

Substances

  • Immunoglobulin G
  • Immunoglobulin M