Rapidly progressing rheumatoid arthritis: an example of polyclonal B-cell activation?

We report the case of a 76-year old woman who presented with a palindromic onset of seropositive rheumatoid arthritis. After suffering from a fulminant pulmonary infection she developed serologic tests for ornitosis, mycoplasma, pneumocystis carinii and low titer yersinia. Also the rheumatoid factor titer increased and the antinuclear antibody test became positive. Clinically, the course of a rather benign polyarthritis changed into a rapidly progressive deforming disease. The course was also complicated by cutaneous necrotizing vasculitis. Further deterioration occurred after a relapse of pulmonary infection, and she died following acute abdominal surgery for perforated sigmoiditis. It is speculated that the clinical course was in part caused by polyclonal B-cell activation.