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Paraneoplastic sacroiliitis
  1. Uri Arad1,2,
  2. Charles Werren3 and
  3. Douglas White1,2
  1. 1Rheumatology, Waikato Hospital, Hamilton, New Zealand
  2. 2Waikato Clinical School, University of Auckland, Hamilton, New Zealand
  3. 3Radiology, Waikato Hospital, Hamilton, New Zealand
  1. Correspondence to Dr Uri Arad; uri.arad{at}


A man in his early 70s presented with stiffness and aching in the shoulder and pelvic girdles. His C reactive protein level was elevated at 116 mg/L, leading to an initial diagnosis of polymyalgia rheumatica. Treatment with prednisone at 20 mg/day provided limited improvement and relapses recurred despite concomitant immunosuppressive agents. Extensive investigations failed to reveal an underlying aetiology.

Five years later, gross painless haematuria led to the detection of an invasive papillary urothelial carcinoma. A review of the staging CT scan revealed findings compatible with bilateral erosive sacroiliitis, which had developed since his initial presentation. Radical cystoprostatectomy provided temporary relief but after a further 9 months, symptoms relapsed, and metastatic spread was discovered.

Paraneoplastic sacroiliitis is a rare clinical entity; and to the best of our knowledge, this is the first reported case associated with a solid tumour.

  • Urological cancer
  • Rheumatology
  • Musculoskeletal syndromes

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: UA, CW and DW. The following authors gave final approval of the manuscript: UA, CW and DW.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.