Polymyalgia rheumatica following robotic radical prostatectomy

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• 作者：T. Suntharasivam ; V.J. Gnanapragasam ; ^{vjg29@cam.ac.uk}
• 关键词：Polymyalgia rheumatica ; Prostatectomy ; Robotic
• 刊名：International Journal of Surgery Case Reports
• 出版年：2012
• 期刊代码：pca193_22102612
• 类别：med
• 出版时间：2012
• 卷：3
• 期：8
• 页码：354-355
• 文件大小：130 K

摘要

INTRODUCTION

Polymyalgia rheumatica (PMR) is an inflammatory syndrome of unknown etiology has also been associated with concurrent malignancy. Here we report PMR occurring de novo in a man following successful robotic radical prostatectomy.

PRESENTATION OF CASE

A 67-year-old gentleman underwent uneventful robotic assisted radical prostatectomy with complete excision of a T2_C Gleason 7 tumour and a post-operative undetectable PSA. Three weeks after surgery he developed pain and weakness of the upper arms requiring increasing doses of opioids. Assessment identified a grossly elevated ESR and CRP consistent with a clinical diagnosis of PMR. Treatment with oral steroids led to a rapid resolution of symptoms.

DISCUSSION

There have been reported cases of polymyalgia rheumatica occurring following surgical procedures but not with robotic prostate surgery. It has been proposed that surgical tissue injury can cause a release of inflammatory markers. Surgical stress-related sympathetic activation can also stimulate lymphocyte dependent inflammatory reactions by modulation of cytokine production and lymphocyte expressed adrenergic receptors.

CONCLUSION

We present here the first reported case of PMR developing acutely after radical robotic prostatectomy. It is possible that the surgical procedure in this case had triggered polymyalgia rheumatica possibly through activation of immune-mediated systemic inflammatory responses.