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A Puzzling Case of Painful Sclerotic Pelvic Lesions

Medscape—March 3, 2015

I am Dr. Stephen Paget, physician-in-chief emeritus at Hospital for Special Surgery.

Today I want to describe an interesting case I saw recently. A 45-year-old woman came to me with painful sclerotic lesions in her right pelvis for about 6 months. When she was 14 years of age, she developed fever, joint pains, and skin rash and was diagnosed as having an undifferentiated connective tissue disease. This was treated with a short course of steroids and some antimalarial drugs. During the next 10 or 15 years, she experienced intermittent flares for which she would take short courses of steroids.

About 2 years ago, she developed a nodular lesion in her right upper arm. The lesion was eventually biopsied and found to be a granulomatous panniculitis. The whole lesion was excised and became a non-problem. Then, around 6 or 8 months ago, she developed the onset of severe left pelvic pain; an x-ray showed sclerotic lesions, and she was told that she had cancer. She eventually went to Memorial Sloan Kettering Cancer Center in New York and physicians there biopsied the lesion. The biopsy showed lymphocytes, some mild granulomatous changes, and no signs of cancer. However, because she had a mildly elevated sedimentation rate and a small monoclonal protein, she underwent a bone marrow biopsy that showed no sign of malignancy or multiple myeloma and no monoclonal disease.

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