Diffuse Large B Cell Lymphoma of the Foot in a Patient with Rheumatoid Arthritis

Anna Litwic,1 Madeleine Sampson,2 Vipul Foria,3 *Elaine Dennison1

1. MRC Lifecourse Epidemiology Unit, Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
2. Radiology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
3. Histopathology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
*Correspondence to emd@mrc.soton.ac.uk

Disclosure: The authors have declared no conflicts of interest.
Received: 16.03.15 Accepted: 27.04.15
Citation: EMJ Rheumatol. 2015;2[1]:84-88.

Abstract

Patients with rheumatoid arthritis (RA) have an increased risk of developing malignant lymphomas, especially non-Hodgkin’s lymphoma (NHL). However, primary lymphoma in a joint is rare. Here we report a case of a 68-year-old man with a background of RA who presented with a 1-year history of pain and swelling in his right ankle. Initial imaging results comprised of X-ray and magnetic resonance imaging were inconclusive. Ultrasound scan of the right foot revealed a very large vascular mass with grossly eroded tarsal bones, and a biopsy confirmed the diagnosis of diffuse large B cell lymphoma. Involvement of lymphoma of ankle/foot joints is very rare: to our knowledge this is the first case of a primary diffuse large B cell lymphoma of the joints of the mid and hind foot with underlying bone destruction in a patient with a background of RA. This case is important because it highlights that malignancy should be suspected in every patient with a background of RA and unusual characteristics before assuming a diagnosis of flare of RA. This is important because early diagnosis of NHL can contribute to improved outcome.

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