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Pseudothrombophlebitis syndrome in late onset rheumatoid arthritis


MOJ Orthopedics & Rheumatology
Salem Bouomrani S,1,2 Nejmeddine Ouannes,1 Ons Mansouri1

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Abstract

Introduction: The term “phlebitis-like” syndrome or pseudothrombophlebitis represents a real diagnostic challenge for the clinician, especially in the elderly subject. It may be secondary to a popliteal cyst, focal myositis, or a disrupted popliteal aneurysm in the calf. We present a case of pseudothrombophlebitis secondary to a broken Baker’s cyst in an elderly patient with rheumatoid arthritis (RA). Observations: A 60-year-old patient, followed for peripheral hypothyroidism related to Hashimoto’s thyroiditis and a well-balanced seropositive RA under disease-modifying antirheumatic drugs (DMARDs) and hormone replacement therapy. She was referred urgently for suspicion of lower limb phlebitis: acute pain with swelling of the right calf with increased calf perimeter, local inflammatory signs and a positive Homans sign. Doppler ultrasound showed no thrombophlebitis but objectified a right popliteal cyst ruptured in the calf. Under oral and topical anti-inflammatory treatment, the evolution was favorable. Conclusion: The ruptured Baker cyst deserves to be known and evoked as possible diagnosis of a large acute leg simulating phlebitis, especially in aged person with RA, because the therapeutic implications are totally different.

Keywords

Phlebitis-like syndrome, pseudothrombophlebitis, popliteal cyst, Baker’s, cyst, rheumatoid arthritis, elderly

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