Kampitak Thatchai
Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Thailand.
Intern Med. 2010;49(15):1641-3. doi: 10.2169/internalmedicine.49.3400. Epub 2010 Aug 2.
A 48-year-old HIV-positive woman presented with progressive pain and stiffness of both shoulders and hips. She was given the diagnosis of polymyalgia rheumatica (PMR) due to high erythrocyte sedimentation rate. However, a 1-week course of prednisolone failed to improve her symptoms. She later discovered a breast lump of which histopathological tissue was consistent with a diffuse large B-cell lymphoma. Whole body bone scan revealed multiple bony metastases. The presence of atypical features of PMR and lack of dramatic response to steroids should prompt physicians to raise the probability of differential diagnoses other than PMR, and in particular, malignancy.
一名48岁的HIV阳性女性出现双肩和双髋部进行性疼痛和僵硬。由于红细胞沉降率高，她被诊断为风湿性多肌痛（PMR）。然而，为期1周的泼尼松龙治疗未能改善她的症状。她后来发现了一个乳腺肿块，其组织病理学检查结果与弥漫性大B细胞淋巴瘤一致。全身骨扫描显示多处骨转移。PMR的非典型特征以及对类固醇缺乏显著反应，应促使医生提高对除PMR之外的其他鉴别诊断的可能性，尤其是恶性肿瘤。
