Autopsy of a case of rheumatoid arthritis with severe bicytopoenia due to gelatinous transformation of the bone marrow

Abstract

We present the case of an elderly female patient with rheumatoid arthritis (RA) treated with methotrexate. She was referred to our hospital with severe malaise. She was emaciated and had massive pleural effusion that induced atelectasis. Her blood tests revealed elevated CRP, leukopenia, and severe anaemia. She lost consciousness on the third day of hospital stay and passed away the following day. Her autopsy showed gelatinous transformation of the bone marrow that gave rise to bicytopoenia, whereas there were no other causes for severe anaemia. Bone marrow gelatinous transformation can cause impaired haematopoiesis in elderly RA patients.

Keywords:

• Cytopoenia
• elderly
• gelatinous transformation
• methotrexate
• rheumatoid arthritis

Acknowledgement

We thank Dr. Akira Isada of Kanai Internal Medicine and Gastroenterology Clinic and Dr. Hideaki Kuramasu of Kuramasu Orthopaedic Clinic for kindly providing the patient’s medical history and data. We would like to thank Editage (www.editage.com) for English language editing.

Patient consent

Patient consent could not be obtained because the patient was deceased. Her family provided the authors with a written consent form for the autopsy and the possibility of presentation and publication.

Ethical statement

Not applicable.

Conflict of interest

None.

Additional information

Funding

The authors did not receive funding for this study.