This case highlights that the diagnosis of malignant effusion should be considered in patients with HTLV-1-associated ATLL who present with joint swelling and that synovial fluid cytology and flow cytometry should be requested.
You Might Also Like
Explore This IssueNovember 2017
Ultrasound is an emerging imaging tool in rheumatology practice that provides valuable information beyond the physical exam. In patients with joint effusions, differentiating DC sign from cartilage interface sign can be difficult. One should obtain synovial fluid for a definitive diagnosis of gout even when the clinical suspicion is high.
Veronika Sharp, MD, is a faculty rheumatologist at the Santa Clara Valley Medical Center (SCVMC) in San Jose, Calif., and an affiliated clinical associate professor at Stanford University, Palo Alto, Calif. She is director of musculoskeletal (MSK) ultrasonography in rheumatology at SCVMC.
Alice Chuang, MD, is an internal medicine resident at SCVMC.
Lily Kao, MD, RMSK, is a rheumatologist in San Jose, Calif., and is a volunteer faculty member at SCVMC in MSK ultrasonography.
Midori Jane Nishio, MD, RhMSUS, is a rheumatologist in Walnut Creek, Calif., and a volunteer faculty member at SCVMC and Stanford University in MSK ultrasonography.
- Koster MJ, McPhail ED, Chowdhary VR. Synovial infiltration in human T lymphotropic virus type I-associated T cell leukemia/lymphoma. Arthritis Rheumatol. 2015 Apr;67(4):945.
- Tachibana J, Shimizu S, Takiguchi T, et al. Lymphomatous polyarthritis in patients with peripheral T-cell lymphoma. Leuk Lymphoma. 1993 Nov;11(5–6):459–467.
- Dennis G, Chitkara P. A case of human T lymphotropic virus type I-associated synovial swelling. Nat Clin Pract Rheumatol. 2007 Nov;3(11):675–680.
- Yancey WB Jr., Dolson LH, Oblon D, et al. HTLV-I-associated adult T-cell leukemia/lymphoma presenting with nodular synovial masses. Am J Med. 1990 Nov;89(5):676–683.
- Terslev L, Gutierrez M, Christensen R, et al. Assessing elementary lesions in gout by ultrasound: Results of an OMERACT patient-based agreement and reliability exercise. J Rheumatol. 2017 Jan;44(1):130.
- YE Miedany. (2015) Musculoskeletal Ultrasonography in Rheumatic Diseases. Switzerland: Springer International Publishing.
- Ogdie A, Taylor WJ, Neogi T, et al. Performance of ultrasound in the diagnosis of gout in a multicenter study comparison with monosodium urate monohydrate crystal analysis as the gold standard. Arthritis Rheumatol. 2017 Feb;69(2):429–438.
- Reuss-Borst MA, Pape CA, Tausche AK. Hidden gout—Ultrasound findings in patients with musculo-skeletal problems and hyperuricemia. Springerplus. 2014 Oct;9;3:592.
- Thiele RG, Schlesinger N. Ultrasonography shows disappearance of monosodium urate crystal deposition on hyaline cartilage after sustained normouricemia is achieved. Rheumatol Int. 2010 Feb;30(4):495–503.