Elderly woman with polyarthritis, heliotrope-like rash, lymphadenopathy and polyneuropathy

A woman in her 80s manifested polyarthritis with anti-citrullinated-protein antibody positivity in April 2021, leading to a diagnosis of rheumatoid arthritis. Although she had taken prednisolone, sulfasalazine and methotrexate, her joint inflammation persisted. In September 2021, she presented facial flushing, black pigmentation on fingers and oedematous erythema of face and eyelid like heliotrope rash (figure 1A). However, muscular weakness and tenderness were not observed, and laboratory test demonstrated no elevated levels of muscular enzymes and myositis-specific/myositis-associated autoantibodies including anti-ARS, MDA-5, TIF-1, Mi-2, Ro and U1-RNP antibodies. Whole-body examination such as CT with intravenous contrast, endoscopic investigation and gynaecological examination showed no findings of lung involvement and malignancy. In October 2021, she developed glove-stocking peripheral demyelinating polyneuropathy. Physical findings revealed slightly tender and hard lymphadenopathy dominantly involving neck and axilla. Laboratory findings showed unexpected positivity of anti-ganglioside GM1 antibody, but no monoclonal immunoglobulins, abnormality of bone marrow and...
Source: Annals of the Rheumatic Diseases - Category: Rheumatology Authors: Tags: ARD, Images in rheumatology Source Type: research