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Abstract
We describe a case of recurrent small cell lung cancer presenting as an acute monoarticular arthritis. This patient had recently undergone comprehensive review and surveillance imaging under a local oncology unit, 18 months after undergoing chemoradiotherapy for limited disease small cell lung cancer. He had presented to the emergency department on multiple occasions and been managed as an outpatient for a provisional diagnosis of spontaneous haemarthrosis in the setting of rivaroxaban therapy. Subsequent investigation revealed occult fracture of the distal femur with joint effusion, secondary to isolated metastatic disease from recurrent small cell lung cancer. This case demonstrates the importance of reconsidering differential diagnoses when a patient’s symptoms do not respond to appropriate treatment as expected. It also highlights the limitations of surveillance protocols and the influence that recent specialist input can have on diagnostic processes.
- lung cancer (oncology)
- radiology
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Footnotes
Contributors JPM was the lead author and was responsible for writing the initial case report and obtaining informed consent from the patient. RT was responsible for obtaining records from the patient’s previous attendances at other institutions and for following up his progress following referral for specialist care. He also assisted with the literature review and editing. NM was primarily responsible for the literature review and for editing assistance. JC was the patient’s primary consultant. He provided consultant oversight for the patient’s care, reviewed the final submission and obtained approval for access to medical records and publication of the case.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.