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Multiple myeloma masquerading as severe seropositive rheumatoid arthritis with subcutaneous nodules and mononeuritis multiplex
Author(s) -
Edavalath Sukesh,
Chowdhury Abhra C.,
Phatak Sanat,
Misra Durga P.,
Verma Ritu,
Lawrence Able
Publication year - 2017
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.12935
Subject(s) - medicine , mononeuritis multiplex , multiple myeloma , polyarthritis , rheumatoid arthritis , rheumatoid nodule , pathology , tenosynovitis , dermatology , biopsy , arthritis , surgery , disease , vasculitis
Multiple myeloma can rarely mimic seronegative rheumatoid arthritis ( RA ). We report a 55‐year‐old woman who presented with longstanding deforming polyarthritis with extensive subcutaneous nodules, tenosynovitis, anti‐cyclic citrullinated peptide positivity and mononeuritis multiplex. Even though the clinical picture was consistent with seropositive RA , the absence of bone erosion or joint space narrowing on hand and knee radiographs led us to question the diagnosis of RA . Further investigation revealed a diagnosis of multiple myeloma with cutaneous amyloid deposits, based on serum immunofixation, bone marrow aspiration and biopsy of a subcutaneous nodule. The only clue to suspect myeloma from the basic investigations and clinical examination was mild hypercalcemia. This case serves to reiterate the need to maintain a heightened suspicion for other diagnoses even when RA appears most likely.