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JAMA Oncology Clinical Challenge
January 16, 2020

A Diffuse Medullary Hypercaptation With No Bone Lesion

Author Affiliations
  • 1Service de Médecine Interne, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
  • 2Institut de Pathologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
  • 3Centre d’Immunothérapie et de Vaccinologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
  • 4Service d’Immunologie et Allergie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
JAMA Oncol. 2020;6(2):291-292. doi:10.1001/jamaoncol.2019.4655

A 71-year-old man had a 3-year history of a recurrent seronegative autoimmune constrictive pericarditis and pleural effusions, which were treated with pericardiectomy and prednisone and azathioprine. The pleural fluid was transudative and sterile, and the pericardium contained focal lymphoplasmacytic aggregates. Attempts to taper immunosuppressive drugs failed because of a recrudescence of the inflammatory syndrome and pericardial effusion. The patient was admitted with fever of unknown origin with a surge of the inflammatory syndrome and pancytopenia. He reported night sweats beginning 3 weeks prior associated with fever and unintentional weight loss. No lymphadenopathy was noted.

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