A swollen knee in a patient with refractory anaemia

CASE REPORT A 63-year old man with refractory anaemia with excess of blasts and a history of heart failure, diabetes and hyperuricaemia, presented with pain, warmth and swelling in the left knee. Blood sample showed white cell blood count 3,840/μL (normal formula), haemoglobin 7.1 g/dL, platelets 11...

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Main Authors: P. Bordin, C. Volpe, G. Anzil, R. Damato, C. Di Loreto
Format: Article
Language:English
Published: PAGEPress Publications 2013-05-01
Series:Italian Journal of Medicine
Subjects:
Online Access:http://www.italjmed.org/index.php/ijm/article/view/290
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spelling doaj-38982519b8504f7fb58b734e10af91ea2020-11-25T04:00:11ZengPAGEPress PublicationsItalian Journal of Medicine1877-93441877-93522013-05-0124232410.4081/itjm.2008.4.23244A swollen knee in a patient with refractory anaemiaP. BordinC. VolpeG. AnzilR. DamatoC. Di LoretoCASE REPORT A 63-year old man with refractory anaemia with excess of blasts and a history of heart failure, diabetes and hyperuricaemia, presented with pain, warmth and swelling in the left knee. Blood sample showed white cell blood count 3,840/μL (normal formula), haemoglobin 7.1 g/dL, platelets 117,000/L, eritrosedimentation rate 66 mm/h, normal serum creatinine and uric acid. He had no history of neutropenia, fever or recurrent infections. X-ray of the knee did not show any erosion or lytic lesion. Arthrocentesis produced turbid fluid, with elevated cell count (81,000/μL, mainly polimorphonuclear cells), no urate crystals, normal chemical pattern, sterile culture. Synovial fluid smear showed a huge neutrophilic cellularity with scattered mononuclear cells looking like medullar myeloid blasts. The microscopic examination identified a myeloid infiltration as the cause of arthritis. <br />DISCUSSION AND CONCLUSIONS Rheumatic phenomena in myelodysplastic syndromes have a prevalence of 10% and include vasculitis, neuropaties, glomerulonephritis, lupus-like syndrome, inflammatory bowel disease, lung infiltrates and arthritis. The pathogenesis is usually autoimmune, as in all paraneoplastic syndromes. In our case, arthritis was due to a direct invasion of blasts. This phenomenon is rarely observed in acute leukemias and was not described yet in myelodysplastic syndromes. Synovial fluid analysis is critical to define the ethiology of an articular effusion, microscopical examination is strongly recommended but it is not always carried out. This case shows how simple diagnostic tests can easily disclose rare conditions.http://www.italjmed.org/index.php/ijm/article/view/290ArthritisSynovial fluidRefractory anaemiaAutoimmune phenomenaMyelodysplastic syndromes.
collection DOAJ
language English
format Article
sources DOAJ
author P. Bordin
C. Volpe
G. Anzil
R. Damato
C. Di Loreto
spellingShingle P. Bordin
C. Volpe
G. Anzil
R. Damato
C. Di Loreto
A swollen knee in a patient with refractory anaemia
Italian Journal of Medicine
Arthritis
Synovial fluid
Refractory anaemia
Autoimmune phenomena
Myelodysplastic syndromes.
author_facet P. Bordin
C. Volpe
G. Anzil
R. Damato
C. Di Loreto
author_sort P. Bordin
title A swollen knee in a patient with refractory anaemia
title_short A swollen knee in a patient with refractory anaemia
title_full A swollen knee in a patient with refractory anaemia
title_fullStr A swollen knee in a patient with refractory anaemia
title_full_unstemmed A swollen knee in a patient with refractory anaemia
title_sort swollen knee in a patient with refractory anaemia
publisher PAGEPress Publications
series Italian Journal of Medicine
issn 1877-9344
1877-9352
publishDate 2013-05-01
description CASE REPORT A 63-year old man with refractory anaemia with excess of blasts and a history of heart failure, diabetes and hyperuricaemia, presented with pain, warmth and swelling in the left knee. Blood sample showed white cell blood count 3,840/μL (normal formula), haemoglobin 7.1 g/dL, platelets 117,000/L, eritrosedimentation rate 66 mm/h, normal serum creatinine and uric acid. He had no history of neutropenia, fever or recurrent infections. X-ray of the knee did not show any erosion or lytic lesion. Arthrocentesis produced turbid fluid, with elevated cell count (81,000/μL, mainly polimorphonuclear cells), no urate crystals, normal chemical pattern, sterile culture. Synovial fluid smear showed a huge neutrophilic cellularity with scattered mononuclear cells looking like medullar myeloid blasts. The microscopic examination identified a myeloid infiltration as the cause of arthritis. <br />DISCUSSION AND CONCLUSIONS Rheumatic phenomena in myelodysplastic syndromes have a prevalence of 10% and include vasculitis, neuropaties, glomerulonephritis, lupus-like syndrome, inflammatory bowel disease, lung infiltrates and arthritis. The pathogenesis is usually autoimmune, as in all paraneoplastic syndromes. In our case, arthritis was due to a direct invasion of blasts. This phenomenon is rarely observed in acute leukemias and was not described yet in myelodysplastic syndromes. Synovial fluid analysis is critical to define the ethiology of an articular effusion, microscopical examination is strongly recommended but it is not always carried out. This case shows how simple diagnostic tests can easily disclose rare conditions.
topic Arthritis
Synovial fluid
Refractory anaemia
Autoimmune phenomena
Myelodysplastic syndromes.
url http://www.italjmed.org/index.php/ijm/article/view/290
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