A Case of Myelofibrosis Associated with Rheumatoid Arthritis / 대한류마티스학회지

ABSTRACT

Rheumatoid arthritis is thought to be a collagen disease induced by autoimmune mechanism of unknown etiology. Idiopathic myelofibrosis is a myeloproliferative disorder in which the large majority of patients is characterized by anemia, leucoerythroblastosis, splenomegaly, and bone marrow fibrosis with a predominance of megakaryocyte. In some patients autoimmune bone marrow damage has been claimed to be involved in the pathogenesis. A 76-year-old female patient was diagnosed to have rheumatoid arthritis 30 years ago and medicated intermittently. Three months ago, she started to take hydroxychloroquine 300mg/day, prednisolone 7.5mg/day and non-steroidal antiinflammatory drug. One month ago, white blood cell (WBC) count was 5,000/ microliter with the neutrophil count was 3000/ microliter, the hemoglobin (Hb) was 4.3g/dL, the platelet count was 95,000/ microliter and the reticulocyte count was 0.1%. The bone marrow biopsy had revealed hypercellular marrow with increased all hematopoietic element. At this time, the WBC count was 1,600/ microliter and the neutrophil count was 760/ microliter, the Hb was 2.7g/dL, the platelet count was 11,000/ microliter and the reticulocyte count was 0.2%. The bone marrow aspiration resulted in dry tap and the biopsy revealed fibrosis with marked degree of reticulin fibrosis and small numbers of hematopoietic cells.