Adenocarcinoma of the lung presenting with polymyalgia rheumatica-like symptoms resolved after resection

Abstract

Background. Lung cancer is usually associated with a variety of paraneoplastic symptoms, but is rarely associated with proximal musculoskeletal symptoms indicative of polymyalgia rheumatica. We describe a case with polymyalgia rheumatica-like symptoms which recovered after resection of adenocarcinoma of the lung. Case. A 62-year-old man with a history of diabetes mellitus and hypertension was hospitalized in November 2008 because he had experienced bilateral pain and stiffness in his proximal thigh muscle and hip for 3 months. A diagnosis of polymyalgia rheumatica was established, but he did not respond to 180 mg/d loxoprofen. He was referred to our hospital because a chest X-ray film revealed an abnormal shadow. No rheumatoid factors or anti-cyclic citrullinated peptide antibodies were detected. Chest computed tomography revealed a 40 x 35-mm tumor in the lower lobe of the right lung. The mass was diagnosed as adenocarcinoma by bronchofiberscopy. Right middle and lower lobectomy with ND2a-2 lymph node dissection were performed. The postoperative diagnosis was pT2aN0M0, pStage IB adenocarcinoma. During the postoperative course, his polymyalgia decreased. However, he continued to experience mild stiffness in his fingers, which resolved after the administration of 60 mg/d loxoprofen. Conclusion. Lung cancer should also be considered in patients presenting with polymyalgia rheumatica-like symptoms. © 2010 The Japan Lung Cancer Society.