Chronic lymphocytic leukaemia and concomitant relapsing polychondritis: a report on one treatment for the combined manifestation of two diseases

SIR, We report the case of a 60-yr-old patient who suffered from chronic lymphocytic leukaemia (CLL) with concomitant relapsing polychondritis. Polychondritic exacerbations were regularly observed with CLL progression and included bilateral painful swellings of the external ear cartilage and of the trachea, disseminated inflammatory polyarthritis, ocular inflammation and a palatal ulceration (Fig. 1). All manifestations of polychondritis and CLL responded well to chlorambucil/prednisone initially, and to cyclophosphamide during later stages of the disease, while the response to methotrexate was poor and treatment with bendamustin was complicated by tumour lysis syndrome and subsequent acute renal failure. Treatment with cyclophosphamide repeatedly induced remissions for both diseases, but was regularly accompanied by serious infectious complications. Relapsing polychondritis is rare and is generally diagnosed clinically if the patient develops at least three of the following signs: bilateral chondritis of the external ears, inflammatory polyarthritis, ocular inflammation, nasal chondritis, vestibular/auditory malfunction and respiratory tract chondritis. Notably, its 5-yr mortality may be as high as 30%, due to collapse of laryngeal and tracheal cartilaginous supporting structures, or cardiovascular involvement. Mild cases may respond to NSAIDs. More severe cases are usually treated with prednisone and may require additional immunosuppressive agents, e.g. cyclophosphamide [1]. The authors have declared no conflicts of interest.