Malignant Peritoneal Mesothelioma Presenting with Polymyalgia Rheumatica-like Syndrome

Our plain-English summary of Malignant Peritoneal Mesothelioma Presenting with Polymyalgia Rheumatica-like Syndrome, by Y. Ide, T. Yuki, Y. Taooka, et al (Internal Medicine, 2020).

The study

• Authors: Y. Ide, T. Yuki, Y. Taooka, Y. Higashi, Y. Tachiyama
• Journal: Internal Medicine
• Published: 2020;59(20):2629-2632
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A 30-year-old man was admitted to our hospital because of pain in his proximal extremities. The pain mimicked polymyalgia rheumatica (PMR) and it temporarily improved by a low dose of glucocorticoids, but his symptoms relapsed many times. After six years of glucocorticoid treatment, he developed abdominal pain and ascites, for which he was diagnosed with malignant peritoneal mesothelioma (MPM). His PMR-like symptoms improved with cytoreductive surgery and chemotherapy for MPM. Finally, we diagnosed this PMR-like syndrome to be paraneoplastic syndrome with MPM. Although cases of MPM complicated by PMR-like syndrome are rare, MPM should be taken into account in the differential diagnosis.

In plain English

This case report describes one man treated at a hospital in Japan. At 30, he arrived with left abdominal pain and severe pain and morning stiffness in his neck, shoulders and hips, resembling polymyalgia rheumatica (PMR), though he was too young to meet its classification criteria. A low dose of the steroid prednisolone gave rapid but temporary relief, and his symptoms relapsed many times over six years. He then developed fever, severe lower abdominal pain and abdominal fluid, and was diagnosed with the epithelial type of malignant peritoneal mesothelioma. He was a professional bus driver, and the authors report he had not been exposed to asbestos. He had surgery and pemetrexed-cisplatin chemotherapy. Steroids were stopped because the muscle pain resolved after a thickened abdominal lesion was removed. The cancer later returned, the muscle symptoms worsened, and he died. The article gives his survival as 6 years after diagnosis in one place and 5 years after starting treatment in another. The authors concluded the PMR-like illness was a paraneoplastic syndrome of the mesothelioma.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One man, aged 30 when first seen, at a hospital in Japan (Akiota Hospital); dates of care not given
• Exposure: No asbestos exposure reported: he was a professional bus driver, his home was wooden, and asbestos was not used in his bus brakes
• Main results:
  • His PMR-like pain and stiffness improved temporarily on low-dose prednisolone (10 mg daily at first, then 3-5 mg daily), but relapsed many times over a 6-year period
  • After 6 years he developed fever, abdominal pain and ascites. CT showed a thickened omentum and an 18 mm lesion in the right subphrenic space, and he was diagnosed with epithelial-type malignant peritoneal mesothelioma
  • He received pemetrexed and cisplatin for 10 cycles. Prednisolone was stopped because the polymyalgia resolved after the thick omental lesion was excised
  • The mesothelioma relapsed, his muscular symptoms gradually worsened, the disease spread within the abdomen and chest, and he died after palliative care
  • The Discussion states he died 6 years after the diagnosis of malignant peritoneal mesothelioma; elsewhere it states he survived 5 years after starting treatment
• The authors' conclusion: The authors concluded that the PMR-like syndrome was a paraneoplastic syndrome of malignant peritoneal mesothelioma, and that clinicians seeing a patient with atypical features of PMR should search carefully for cancers, including this one

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Ascites, Cytoreductive Surgery, Chemotherapy, Differential Diagnosis.

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